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Suicidal ideation, deliberate self-harm behaviour and suicide attempts among adolescent outpatients with depressive mood disorders and comorbid axis I disorders

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Abstract

Objective

We aimed to analyse and compare prevalence and associated clinical features of suicidal ideation, self-harm behaviour with no suicidal intent and suicide attempts among adolescent outpatients with depressive mood disorders with or without comorbidity.

Method

A sample of 218 consecutive adolescent outpatients aged 13–19 years with depressive mood disorders was interviewed using K-SADS-PL for DSM-IV Axis I diagnoses. They filled out self-report questionnaires assessing depressive and anxiety symptoms. Suicidal behaviour was assessed by K-SADS-PL suicidality items.

Results

Half of the subjects reported suicidal ideation or behaviour. There was no difference in prevalence of suicidal behaviour between non-comorbid and comorbid mood disorder groups. Multivariate logistic regression analyses produced the following associations: (1) suicidal ideation with self-reported depressive symptoms and poor psychosocial functioning, (2) deliberate self-harm behaviour with younger age and poor psychosocial functioning, and (3) suicide attempts with self-reported depressive symptoms and poor psychosocial functioning.

Conclusions

Depressed mood disorders, whether comorbid or not, are associated with suicidal ideation and suicide attempts. Diagnostic assessment should be supplemented by self-report methods when assessing suicidal behaviour in depressed adolescents.

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References

  1. Aalto-Setälä T, Marttunen M, Tuulio-Henriksson A, Poikolainen K, Lönnqvist J (2002) Psychiatric treatment seeking and psychosocial impairment among young adults with depression. J Affect Disord 70:35–47

    Article  PubMed  Google Scholar 

  2. American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders: DSM-IV. American Psychiatric Association, Washington DC

    Google Scholar 

  3. Angold A, Costello EJ, Erkanli A (1999) Comorbidity. J Child Psychol Psychiatry 40:57–87

    Article  PubMed  CAS  Google Scholar 

  4. Beautrais AL (2003) Suicide and serious suicide attempts in youth: a multiple-group comparison study. Am J Psychiatry 160:1093–1099

    Article  PubMed  Google Scholar 

  5. Beautrais AL, Joyce PR, Mulder RT (1998) Psychiatric illness in a New Zealand sample of young people making serious suicide attempts. NZ Med J 111:44–48

    CAS  Google Scholar 

  6. Beautrais AL, Joyce PR, Mulder RT (1996) Risk factors for serious suicide attempts among youths aged 13 through 24 years. J Am Acad Child Adolesc Psychiatry 35:1174–1182

    Article  PubMed  CAS  Google Scholar 

  7. Beck AT, Epstein N, Brown G, Steer RA (1988) An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 56:893–897

    Article  PubMed  CAS  Google Scholar 

  8. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:561–571

    PubMed  CAS  Google Scholar 

  9. Briere J, Gil E (1998) Self-mutilation in clinical and general population samples: prevalence, correlates, and functions. Am J Orthopsychiatry 68:609–620

    PubMed  CAS  Google Scholar 

  10. Brooks SJ, Kutcher S (2001) Diagnosis and measurement of adolescent depression: a review of commonly utilized instruments. J Child Adolesc Psychopharmacol 11:341–376

    Article  PubMed  CAS  Google Scholar 

  11. Darche M (1990) Psychological Factors differentiating self-mutilating and non-self-mutilating adolescent inpatients females. Psychiatr Hospital 21:31–35

    Google Scholar 

  12. Esposito CL, Clum GA (2002) Psychiatric symptoms and their relationship to suicidal ideation in a high-risk adolescent community sample. J Am Acad Child Adolesc Psychiatry 41:44–51

    Article  PubMed  Google Scholar 

  13. Esposito CL, Clum GA (2003) The relative contribution of diagnostic and psychosocial factors in the prediction of adolescent suicidal ideation. J Clin Child Adolesc Psychol 32:386–395

    Article  PubMed  Google Scholar 

  14. Feehan M, McGee R, Williams SM (1993) Mental health disorders from age 15 to age 18 years. J Am Acad Child Adolesc Psychiatry 32:1118–1126

    PubMed  CAS  Google Scholar 

  15. Fergusson DM, Lynskey MT (1995) Suicide attempts and suicidal ideation in a birth cohort of 16-year-old New Zealanders. J Am Acad Child Adolesc Psychiatry 34:1308–1317

    Article  PubMed  CAS  Google Scholar 

  16. Fleiss J, Cohen J (1973) The equivalence of weighted kappa and the intraclass correlation coefficient as measures of reliability. Educ Psychol Meas 33:6113–6619

    Google Scholar 

  17. Ghaziuddin N, King CA, Naylor MW, Ghaziuddin M (2000) Anxiety contributes to suicidality in depressed adolescents. Depress Anxiety 11:134–138

    Article  PubMed  CAS  Google Scholar 

  18. Goldberg D (1972) The detection of minor psychiatric illness by questionnaire. Oxford University Press, Oxford

    Google Scholar 

  19. Goldston DB, Daniel SS, Reboussin BA, Reboussin DM, Kelley AE, Frazier PH (1998) Psychiatric diagnoses of previous suicide attempters, first-time attempters, and repeat attempters on an adolescent inpatient psychiatry unit. J Am Acad Child Adolesc Psychiatry 37:924–932

    Article  PubMed  CAS  Google Scholar 

  20. Gould S, King R, Greenwald S, Fisher P, Schwab-Stone M, Kramer R, Flisher A, Goodman S, Canino G, Schaffer D (1998) Psychopathology associated with suicidal ideation and attempts among children and adolescents. J Am Acad Child Adolesc Psychiatry 37:915–923

    Article  PubMed  CAS  Google Scholar 

  21. Groholt B, Ekeberg O, Haldorsen T (2000) Adolescents hospitalised with deliberate self-harm: the significance of an intention to die. Eur Child Adolesc Psychiatry 9:244–254

    Article  PubMed  CAS  Google Scholar 

  22. Guertin T, Lloyd-Richardson E, Spirito A, Donaldson D, Boergers J (2001) Self-mutilative behavior in adolescents who attempt suicide by overdose. J Am Acad Child Adolesc Psychiatry 40:1062–1069

    Article  PubMed  CAS  Google Scholar 

  23. Gurley D, Cohen P, Pine DS, Brook J (1996) Discriminating depression and anxiety in youth: a role for diagnostic criteria. J Affect Disord 39:191–200

    Article  PubMed  CAS  Google Scholar 

  24. Hamilton J, Gillham J (1999) The K-SADS and diagnosis of major depressive disorder. J Am Acad Child Adolesc Psychiatry 38:1065–1069

    Article  PubMed  CAS  Google Scholar 

  25. Hawton K, Houston K, Haw C, Townsend E, Harriss L (2003) Comorbidity of axis I and axis II disorders in patients who attempted suicide. Am J Psychiatry 160:1494–1500

    Article  PubMed  Google Scholar 

  26. Hawton K, Rodham K, Evans E, Weatherall R (2002) Deliberate self harm in adolescents: self report survey in schools in England. BMJ 325:1207–1211

    Article  PubMed  Google Scholar 

  27. Kaufman J, Birmaher B, Brent DA, Rao U, Flynn C, Moreci P, Williamson DE, Ryan ND (1997) Schedule for Affective Disorders and Schizophrenia for School-Age Children – Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 36:980–987

    Article  PubMed  CAS  Google Scholar 

  28. Kessler RC, Avenevoli S, Ries Merikangas K (2001) Mood disorders in children and adolescents: an epidemiologic perspective. Biol Psychiatry 49:1002–1014

    Article  PubMed  CAS  Google Scholar 

  29. Klonsky ED, Oltmanns TF, Turkheimer E (2003) Deliberate self-harm in a nonclinical population: prevalence and psychological correlates. Am J Psychiatry 160:1501–1508

    Article  PubMed  Google Scholar 

  30. Kosky R, Silburn S, Zubrick SR (1990) Are children and adolescents who have suicidal thoughts different from those who attempt suicide? J Nerv Mental Dis 178:38–43

    CAS  Google Scholar 

  31. Kovacs M, Gatsonis C, Paulauskas SL, Richards C (1989) Depressive disorders in childhood. IV. A longitudinal study of comorbidity with and risk for anxiety disorders. Arch Gen Psychiatry 46:776–782

    PubMed  CAS  Google Scholar 

  32. Kovacs M, Goldston D, Gatsonis C (1993) Suicidal behaviors and childhood-onset depressive disorders: a longitudinal investigation. J Am Acad Child Adolesc Psychiatry 32:8–20

    PubMed  CAS  Google Scholar 

  33. Lewinsohn PM, Rohde P, Seeley JR (1995) Adolescent psychopathology: III. The clinical consequences of comorbidity. J Am Acad Child Adolesc Psychiatry 34:510–519

    Article  PubMed  CAS  Google Scholar 

  34. Lewinsohn PM, Rohde P, Seeley JR (1996) Adolescent suicidal ideation and attempts: prevalence, risk factors, and clinical implications. Clin Psychol Sci Pract 3:25–46

    Article  Google Scholar 

  35. Lewinsohn PM, Zinbarg R, Seeley JR, Lewinsohn M, Sack WH (1997) Lifetime comorbidity among anxiety disorders and between anxiety disorders and other mental disorders in adolescents. J Anxiety Disord 11:377–394

    Article  PubMed  CAS  Google Scholar 

  36. Martin G, Rozanes P, Pearce C, Allison S (1995) Adolescent suicide, depression and family dysfunction. Acta Psychiatr Scand 92:336–344

    PubMed  CAS  Google Scholar 

  37. Muehlenkamp JJ, Gutierrez PM (2004) An investigation of differences between self-injurious behavior and suicide attempts in a sample of adolescents. Suicide Life Threat Behav 34:12–23

    Article  PubMed  Google Scholar 

  38. Myers K, Winters NC (2002) Ten-year review of rating scales. II: Scales for internalizing disorders. J Am Acad Child Adolesc Psychiatry 41:634–659

    Article  PubMed  Google Scholar 

  39. Pelkonen M, Marttunen M, Laippala P, Lonnqvist J (2000) Factors associated with early dropout from adolescent psychiatric outpatient treatment. J Am Acad Child Adolesc Psychiatry 39:329–336

    Article  PubMed  CAS  Google Scholar 

  40. Pelkonen M, Marttunen M, Pulkkinen E, Laippala P, Aro H (1997) Characteristics of out-patient adolescents with suicidal tendencies. Acta Psychiatr Scand 95:100–107

    PubMed  CAS  Google Scholar 

  41. Rohde P, Lewinsohn PM, Seeley JR (1991) Comorbidity of unipolar depression: II. Comorbidity with other mental disorders in adolescents and adults. J Abnormal Psychol 100:214–222

    Article  CAS  Google Scholar 

  42. Ross S, Heath N (2002) A study of the frequency of self-mutilation in a community sample of adolescents. J Youth Adolesc 31:67–77

    Article  Google Scholar 

  43. Sanford M, Szatmari P, Spinner M, Munroe-Blum H, Jamieson E, Walsh C, Jones D (1995) Predicting the one-year course of adolescent major depression. J Am Acad Child Adolesc Psychiatry 34:1618–1628

    Article  PubMed  CAS  Google Scholar 

  44. SAS Institute Inc. (1999) SAS Online Doc, Version 8. SAS Institute Inc, Cary, NC

    Google Scholar 

  45. Shanee N, Apter A, Weizman A (1997) Psychometric properties of the K-SADS-PL in an Israeli adolescent clinical population. Isr J Psychiatry Relat Sci 34:179–186

    PubMed  CAS  Google Scholar 

  46. SPSS Inc. (2001) SPSS Base 11.0 for Windows User’s Guide. SPSS Inc., Chigaco, IL

    Google Scholar 

  47. Strauss J, Birmaher B, Bridge J, Axelson D, Chiappetta L, Brent D, Ryan N (2000) Anxiety disorders in suicidal youth. Can J Psychiatry (Revue Canadienne de Psychiatrie) 45:739–745

    CAS  Google Scholar 

  48. Suymoto K (1998) The functions of self-mutilation. Clin Psychol Rev 18:531–554

    Article  Google Scholar 

  49. Wetzler S, Asnis GM, Hyman RB, Virtue C, Zimmerman J, Rathus JH (1996) Characteristics of suicidality among adolescents. Suicide Life Threat Behav 26:37–45

    PubMed  CAS  Google Scholar 

  50. Wunderlich U, Bronisch T, Wittchen HU (1998) Comorbidity patterns in adolescents and young adults with suicide attempts. Eur Arch Psychiatry Clin Neurosci 248:87–95

    Article  PubMed  CAS  Google Scholar 

  51. Zlotnick C, Donaldson D, Spirito A, Pearlstein T (1997) Affect regulation and suicide attempts in adolescent inpatients. J Am Acad Child Adolesc Psychiatry 36:793–798

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

We thank research assistant Mrs. Eevaliisa Orelma for her contribution in patient recruitment and data management and Hannele Heilä, M.D., Ph.D., Johanna Törrönen, M.D., and Kirsi Kettunen, M.D. for their contribution in the interviews. This study was financially supported by the Yrjö Jahnsson Foundation and Finnish Cultural Foundation.

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Authors and Affiliations

  1. Dept. of Mental Health and Alcohol Research, National Public Health Institute, Mannerheimintie 166, 00300, Helsinki, Finland

    Virpi Tuisku MSocSc, Mirjami Pelkonen PhD, Linnea Karlsson MD, PhD, Olli Kiviruusu MSocSc, Matti Holi MD, PhD, Titta Ruuttu MA & Mauri Marttunen MD, PhD

  2. Dept. of Psychology, Tampere University, Tampere, Finland

    Virpi Tuisku MSocSc & Raija-Leena Punamäki PhD

  3. Dept. of Adolescent Psychiatry, Peijas Hospital, , Helsinki University Hospital, Vantaa, Finland

    Mirjami Pelkonen PhD, Titta Ruuttu MA & Mauri Marttunen MD, PhD

  4. Dept. of Psychiatry, Turku University Central Hospital, Turku, Finland

    Linnea Karlsson MD, PhD

  5. Dept. of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland

    Matti Holi MD, PhD

  6. Dept. of Psychiatry, University of Kuopio, Kuopio, Finland

    Mauri Marttunen MD, PhD

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  1. Virpi Tuisku MSocSc
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Correspondence to Virpi Tuisku MSocSc.

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Tuisku, V., Pelkonen, M., Karlsson, L. et al. Suicidal ideation, deliberate self-harm behaviour and suicide attempts among adolescent outpatients with depressive mood disorders and comorbid axis I disorders. Eur Child Adolesc Psychiatry 15, 199–206 (2006). https://doi.org/10.1007/s00787-005-0522-3

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