Parameters of Suicidal Crises Vary as a Function of Previous Suicide Attempts in Youth Inpatients

doi:10.1097/00004583-200007000-00016

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 39, Issue 7, July 2000, Pages 876-880

https://doi.org/10.1097/00004583-200007000-00016 Get rights and content

ABSTRACT

Objectives

Although suicidal crises demand an enormous amount of clinical attention, surprisingly little empirical research has been conducted on the parameters of suicidal crises in general, and in children and adolescents in particular. On the basis of past conceptual work on the unique characteristics of multiple suicide attempters, as well as work on the effect of previous suicidal and depressive experience on later functioning, the authors developed predictions regarding the intensity and duration of suicidal crises in youths presenting to inpatient psychiatry units. Specifically, it was hypothesized that multiple attempt status would relate significantly to intensity of suicidal crises and would relate more strongly to intensity than to duration of crises.

Method

Data on past suicide history and self-rated symptoms were collected for 50 suicidal patients, all of whom were available at follow-up.

Results

Findings conformed to prediction: Multiple attempters experienced more intense but not more long-lasting crises; the relation between multiple attempt status and crisis intensity exceeded that between multiple attempt status and crisis duration.

Conclusions

Previous suicidal experience may alter the parameters of current suicidal crises. Implications of these findings for suicide risk and clinical assessment and management are discussed.

Section snippets

Participants

A total of 50 participants were obtained from admissions to the child and adolescent inpatient units at the University of Texas Medical Branch. All admissions to these units were routinely screened for suicidal symptoms. Those who endorsed any suicidal ideation on Item 9 of the Children's Depression Inventory (CDI) and whose ideation was documented in the admission note and confirmed by structured clinical interview were included. For this study, 78 patients were screened, 52 of whom had

RESULTS

Means, standard deviations, and correlations are presented in Table 1. As can be seen there, the baseline mean for the CDI (T score of 67.48; SD = 12.37) exceeds a common cutoff score for clinical significance (T score of 65) (Kovacs, 1992), as would be expected in an inpatient sample. As would also be expected in a sample undergoing intensive treatment, CDI scores at discharge dropped substantially (T score of 57.11; SD = 11.49).

Test-retest reliability for the CDI was 0.70, within the expected

DISCUSSION

Considering the attention suicidal crises absorb in clinical settings, it is surprising that relatively little empirical research has been conducted on the parameters of suicidal crises. In the context of past conceptual work on the difference between multiple attempters and other people (e.g., Rudd et al., 1996a), as well as on the effect of previous suicidal and depressive experience on later functioning (Beck, 1996, Post et al., 1996, Teasdale, 1988), we examined a group of suicidal youths

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The development and testing of this new quality measure is an important first step toward addressing the dearth of quality measures available to assess pediatric hospital-based mental health care. Attempting suicide is a leading predictor of subsequent suicide attempts.58–61 Thus, implementing best practices for youth presenting to the ED with suicidal ideation or self-harm has the potential to improve the care of a large proportion of those at risk for future suicide attempts.
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Based on a conceptual framework, evidence review, and a modified Delphi process, we developed a quality measure assessing whether youth 5 to 17 years old evaluated for suicidal ideation or self-harm in the ED and discharged to home had a follow-up mental health care visit within 7 days. The measure was tested in 4 geographically dispersed states (California, Pennsylvania, South Carolina, Tennessee) using Medicaid administrative data. We examined measure feasibility of implementation, variation, reliability, and validity. To test validity, adjusted regression models examined associations between quality measure scores and subsequent all-cause and same-cause hospital readmissions/ED return visits.
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This new ED quality measure may be useful for monitoring and improving the quality of care for this vulnerable population; however, future work is needed to establish the measure's predictive validity using more prevalent outcomes such as recurrence of suicidal ideation or deliberate self-harm.
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Both, BPD (Yen et al., 2021) and a history of suicide attempt are among the most powerful, nomothetic long-term predictors of lethal suicidal behavior (Christiansen & Frank Jensen, 2007; Suominen et al., 2004). Thus, individuals with a history of high-lethality suicide attempts likely share characteristics and processes with those that died by suicide as the lethality of suicide attempts progresses with repeated attempts (Malone, Haas, Sweeney, & Mann, 1995), and a history of multiple suicide attempts has been associated with more frequent and longer lasting high risk states (Bryan, Clemans, Leeson, & Rudd, 2015; Joiner, Rudd, Rouleau, & Wagner, 2000). Written informed consent was obtained prior to participation.
Acute risk of death by suicide manifests in heightened suicidal ideation in certain contexts and time periods. These increases are thought to emerge from complex and mutually reinforcing relationships between dispositional vulnerability factors and individually suicidogenic short-term stressors. Together, these processes inform clinical safety planning and our therapeutic tools accommodate a reasonable degree of idiosyncrasy when we individualize interventions. Unraveling these multifaceted factors and processes on a quantitative level, however, requires estimation frameworks capable of representing idiosyncrasies relevant to intervention and psychotherapy. Using, data from a 21-day ambulatory assessment protocol that included six random prompts per day, we developed personalized (i.e., idiographic) models of interacting risk factors and suicidal ideation via Group Iterative Multiple Model Estimation (GIMME) in a sample of people diagnosed with borderline personality disorder (N = 95) stratified for a history of high lethality suicide attempts. Our models revealed high levels of heterogeneity in state risk factors related to suicidal ideation, with no features shared among the majority of participants or even among relatively homogenous clusters of participants (i.e., empirically derived subgroups). We discuss steps toward clinical implementation of personalized models, which can eventually capture suicidogenic changes in proximal risk factors and inform safety planning and interventions.
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The aims of this study were to evaluate and compare the performance of the Chinese version of the Suicide Ideation Scale-Current (SSI-C) and the Suicide Ideation Scale-Worst (SSI-W) as suicide ideation screening tools in patients with epilepsy (PWE).
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A total of 260 consecutive PWE were recruited. The area under the curve (AUC) for the SSI-C was 0.831, and the optimal cutoff score was > 1 (sensitivity 73%, specificity 91%); for the SSI-W, the AUC was 0.958, and the optimal cutoff score was > 2 (sensitivity 94.6%, specificity 87.4%). The AUC for the SSI-W was larger than that for the SSI-C, and the two-factor structure was considered significant.
Our results showed that the SSI-C and SSI-W had good validity as suicidal ideation screening tools in PWE in southern China and can be recommended for clinical suicidal ideation screening. The SSI-W is a better suicidal ideation screening tool than the SSI-C according to the results of our study.
Patterns of change in suicide ideation signal the recurrence of suicide attempts among high-risk psychiatric outpatients
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Suicide ideation is an inherently dynamic construct. Previous research implicates different temporal patterns in suicide ideation among individuals who have made multiple suicide attempts as compared to individuals who have not. Temporal patterns among first-time attempters might therefore distinguish those who eventually make a second suicide attempt. To test this possibility, the present study used a dynamical systems approach to model change patterns in suicide ideation over the course of brief cognitive behavioral therapy for suicide prevention (12 sessions total) among 33 treatment-seeking active duty Soldiers with one prior suicide attempt. Variable-centered models were constructed to determine if change patterns differed between those with and without a follow-up suicide whereas person-centered models were constructed to determine if within-person change patterns were associated with eventual suicide attempts. Severity of suicide ideation was not associated with the occurrence of suicide attempts during follow-up, but person-centered temporal patterns were. Among those who made an attempt during follow-up, suicide ideation demonstrated greater within-person variability across treatment. Results suggest certain change processes in suicide ideation may characterize vulnerability to recurrent suicide attempt among first-time attempters receiving outpatient behavioral treatment. Nonlinear dynamic models may provide advantages for suicide risk assessment and treatment monitoring in clinical settings.
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to estimate the prevalence of depression at 4-week postpartum using the Edinburgh postpartum Depression Scale (EPDS) in women who delivered in a public maternity hospital in Argentina.
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The kindling effect is used to describe diseases where each episode of the illness makes later episodes both more likely and more severe. For suicide risk, this mechanism has been explored as a possible important factor, although no definite conclusion has emerged (Joiner and Rudd, 2000; Joiner et al., 2000; Pettit et al., 2004). Levine et al. (2010) investigated suicide risk in patients at the time of first admission and during early course schizophrenia.
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: Portions of this work were supported by grants from the NIMH (MH48097) and the American Foundation for Suicide Prevention.

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ARTICLESParameters of Suicidal Crises Vary as a Function of Previous Suicide Attempts in Youth Inpatients

ABSTRACT

Objectives

Method

Results

Conclusions

Section snippets

Participants

RESULTS

DISCUSSION

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

Beyond belief: a theory of modes, personality, and psychopathology

Self-verification in youth psychiatric inpatients

J Abnorm Psychol

Rating scales to assess depression in school-aged children

Acta Paedopsychiatr

Children's Depression Inventory Manual

ARTICLES
Parameters of Suicidal Crises Vary as a Function of Previous Suicide Attempts in Youth Inpatients