Predicting Future Suicide Attempts Among Adolescent and Emerging Adult Psychiatric Emergency Patients

Abstract

Objective The purpose of this study was to longitudinally examine specific characteristics of suicidal ideation in combination with histories of suicide attempts and non-suicidal self-injury (NSSI) to best evaluate risk for a future attempt among high-risk adolescents and emerging adults. Method Participants in this retrospective medical record review study were 473 (53% female; 69% Caucasian) consecutive patients, ages 15–24 years (M = 19.4 years) who presented for psychiatric emergency (PE) services during a 9-month period. These patients’ medical records, including a clinician-administered Columbia-Suicide Severity Rating Scale, were coded at the index visit and at future visits occurring within the next 18 months. Logistic regression models were used to predict suicide attempts during this period. Results SES, suicidal ideation severity (i.e., intent, method), suicidal ideation intensity (i.e., frequency, controllability), a lifetime history of suicide attempt, and a lifetime history of NSSI were significant independent predictors of a future suicide attempt. Suicidal ideation added incremental validity to the prediction of future suicide attempts above and beyond the influence of a past suicide attempt, whereas a lifetime history of NSSI did not. Sex moderated the relationship between the duration of suicidal thoughts and future attempts (predictive for males, but not females). Conclusions Results suggest value in incorporating both past behaviors and current thoughts into suicide risk formulation. Furthermore, suicidal ideation duration warrants additional examination as a potential critical factor for screening assessments evaluating suicide risk among high-risk samples, particularly for males.

Positive and Negative Expectations of Hopelessness as Longitudinal Predictors of Depression, Suicidal Ideation, and Suicidal Behavior in High‐Risk Adolescents

“…The C-SSRS has been used in many settings (Posner et al, 2011) and has predictive validity for adolescent suicide attempts (Gipson, Agarwala, Opperman, Horwitz, & King, 2015; Horwitz, Czyz, & King, 2015). …”

Multi-modal neuroimaging of adolescents with non-suicidal self-injury: Amygdala functional connectivity

“…Worldwide prevalence has been estimated to be approximately 18% (Muehlenkamp et al, 2012). NSSI may predict negative outcomes such as persistent psychopathology and suicide (Horwitz et al, 2014; Tang et al, 2011; Victor and Klonsky, 2014). In order to promote the development of novel, biologically-informed treatments, new research is needed to advance understanding of the neurobiological mechanisms associated with this behavior.…”

Double RASS cutpoint accurately diagnosed suicidal risk in females with long-term conditions attending the emergency department compared to their male counterparts

“…This finding is important, as the suicide rate in males is higher than females [21], and it has been pointed out that while suicide "attempters" readily report their intentions, suicide "completers" often conceal their thoughts and plans [13,45]. Gender differences regarding the predictive validity of suicide ideation for suicide attempts have been also reported, and suicidal ideation was a significant predictor of subsequent suicide attempts for psychiatrically hospitalized adolescent girls, but not boys [46], while the duration of suicidal thoughts predicted future attempts for adolescent and emerging adult psychiatric emergency male patients but not female ones [47]. Increasing, therefore, the required for an effective assessment of suicidal risk cutpoint in males attending the ED may be an asset in our efforts to prevent suicidal behavior.…”