Abstract
Background: In children and adolescents with a depressive disorder, predicting who will also go on to exhibit suicide-related behaviors (SRBs), including suicide attempt or self-harm, is a key challenge facing clinicians. Aims: To investigate the relative contributions of depressive disorder severity, hopelessness, family dysfunction, and perceived social support to the risk of suicide-related behaviors. Methods: This was a cross-sectional study of a group of 10–16-year-olds with major depressive disorders and dysthymic disorder. Results: Child-rated depressive disorder symptom severity emerged as the greatest predictor of risk. Hopelessness and family dysfunction were also significant predictors of SRBs. In combination these variables were strong predictors, accounting for 66% of the variance. This is a cross-sectional study design, rather than longitudinal, therefore risk prediction over time was not possible. Conclusions: Understanding the child and adolescents depressive disorder symptom severity from their perspective, their level of hopelessness, as well as their family context is critical in understanding the risk of SRBs. These findings may help to provide direction for targeted interventions to address these clinical risk factors.
References
1983). Manual for the Child Behavior Checklist and Behavior Profile. Burlington: University of Vermont.
(1992). Suicide attempts among older adolescents: Prevalence and co-occurrence with psychiatric disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 655–662.
(1988). Childhood and adolescent depression I: Epidemiological and etiological aspects. British Journal of Psychiatry, 152, 601–617.
(1992). Suicidal ideation and attempts during middle childhood: Associations with perceived family stress and depression among child psychiatric inpatients. Journal of Clinical Child Psychology, 21, 35–40.
(1996). Prediction of adolescent affective disorder: Effects of prior parental affective disorders and child psychopathology. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 279–288.
(1998). Psychiatric illness in a New Zealand sample of young people making serious suicide attempts. New Zealand Medical Journal, 111, 44–48.
(2000). Risk factors for suicide and attempted suicide among young people. Australian and New Zealand Journal of Psychiatry, 34, 420–436.
(1967). Depression: Clinical, experimental and theoretical aspects. New York: Hober.
(1986). Psychopathology and its relationship to suicidal ideation in childhood and adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 25, 666–673.
(1990). Suicidality in affectively disordered adolescent inpatients. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 596–593.
(2006). Adolescent suicide and suicidal behavior. Journal of Child Psychology and Psychiatry, 47, 372–394.
(2003). Psychological autopsy studies of suicide: A systematic review. Psychological Medicine, 33, 395–405.
(2005). Clinical predictors of suicide in primary major depressive disorder. Journal of Clinical Psychiatry, 66, 412–417.
(2004). Who are the kids who self-harm? An Australian self-report school survey. Medical Journal of Australia, 181, 140–144.
(2001). Suicidal behaviors in adolescents. In , The depressed child and adolescent (2nd ed., pp. 267–291). Cambridge: Cambridge University Press.
(1993). The specificity of psychological characteristics of adolescent suicide attempters. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 51–59.
(1994). Social support, life events, and behavioral characteristics of psychologically distressed adolescents at high risk for attempting suicide. Adolescence, 29(113), 49–60.
(1974). The Hopkins Symptom Checklist (HSCL): A self-report measure inventory. Behavioral Science, 19, 1–14.
(1983). The McMaster Family Assessment Device. Journal of Marital and Family Therapy, 9, 171–180.
(2002). Psychiatric symptoms and their relationship to suicidal ideation in a high-risk adolescent community sample. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 44–51.
(2005). Effects of social networks on 10-year survival in very old Australians: The Australian longitudinal study of aging. Journal of Epidemiology and Community Health, 59, 574–579.
(2006). Predictors of suicide attempts: State and trait components. Journal of Abnormal Psychology, 115, 842–849.
(2003). Youth suicide risk and preventive interventions: A review of the Past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 386–405.
(2002). Religiosity, attributional style, and social support as psychosocial buffers for African American and White adolescents’ perceived risk for suicide. Suicide and Life Threatening Behavior, 32, 404–417.
(2000). Young suicide attempters: A comparison between a clinical and epidemiological sample. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 868–875.
(2004). Youth risk behavior surveillance – United States 2003. MMWR Surveillance Summaries: Morbidity and Mortality Weekly Report Surveillance Summaries/CDC, 53(2), 1–96.
(1982). Motivational aspects of deliberate self-poisoning in adolescents. British Journal of Psychiatry, 141, 286–291.
(2002). Deliberate self-harm in adolescents: Self-report survey in schools in England. British Medical Journal, 325, 1207–1211.
(2009). Suicide. Lancet, 373, 1372–1381.
(2008). In young people with a depressive disorder, does diagnostic specificity matter in the prediction of suicidality? Australian e-Journal for the Advancement of Mental Health, 7(3) www.auseinet.com/journal/vol7iss3/hetrick.pdf
(2002). The trajectory of suicidal behavior over time. Suicide and Life-Threatening Behavior, 32, 33–41.
(2005). The psychology and neurobiology of suicidal behavior. Annual Review of Psychology, 56, 287–314.
(2005). Social networks and health: Its time for an intervention trial. Journal of Epidemiology and Community Health, 59, 537–538.
(1986). The Hopelessness Scale for Children: Psychometric characteristics and concurrent validity. Journal of Consulting and Clinical Psychology, 54, 241–245.
(1992). Differences between adolescent attempters and depressed adolescents. Acta Psychiatrica Scandinavica, 85, 222–228.
(1990). Psychological factors associated with urban adolescent female suicide attempts. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 289–294.
(1999). Do adolescents who take overdoses have specific psychological characteristics? A comparative study with psychiatric and community controls. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1125–1131.
(1996). Symptomatology in dysthymic and major depressive disorder. The Psychiatric Clinics of North America, 19, 41–53.
(1986). Symptomatic depression and suicidal ideation: A comparative study with 628 children. Journal of Nervous and Mental Disorders, 174, 523–528.
(1992). The Children’s Depression Inventory. North Tonawanda, NY: Mental Health Systems.
(1994). Childhood-onset dysthymic disorder: Clinical features and prospective naturalistic outcomes. Archives of General Psychiatry, 51, 365–374.
(1993). Psychosocial characteristics of adolescents with a history of suicide attempts. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 60–69.
(1996). Adolescent suicidal ideation and attempts: Prevalence, risk factors and clinical implications. Clinical Psychology: Science and Practice, 3, 25–46.
(2003). Neurobiology of suicidal behavior. Nature Reviews Neuroscience, 4, 819–828.
(1998). A longitudinal investigation of depression, hopelessness, social support, and minor life events and their relation to suicidal ideation in adolescents. Suicide and Life-Threatening Behavior, 28, 358–374.
(1983). Measures of perceived social support from friends and family: Three validation studies. American Journal of Community Psychology, 11, 1–24.
(1987). The clinical picture of major depression in children and adolescents. Archives of General Psychiatry, 44(854–861).
(1996). Psychiatric diagnosis in child and adolescent suicide. Archives of General Psychiatry, 53, 338–348.
(1996). Anxiety Disorders Interview Schedule for DSM-IV. Texas: Graywind.
(1996). Using multivariate statistics (3rd ed.). New York: Harper Collins.
(1986). Conduct disorder & hyperactivity: I. Separation of hyperactivity and antisocial conduct in British child psychiatric patients. British Journal of Psychiatry, 149, 760–767.
(2004). National intelligence and suicide rate: An ecological study of 85 countries. Personality and Individual Differences, 37, 543–553.
(2005). Global suicide rates among young people aged 15–19. World Psychiatry, 4, 114–120.
(1991). Wechsler Intelligence Scale for Children – Third edition. San Antonio: The Psychological Corporation.
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