David A Brent1, Laurence L Greenhill2, Scott Compton2, Graham Emslie2, Karen Wells2, John T Walkup2, Benedetto Vitiello2, Oscar Bukstein2, Barbara Stanley2, Kelly Posner2, Betsy D Kennard2, Mary F Cwik2, Ann Wagner2, Barbara Coffey2, John S March2, Mark Riddle2, Tina Goldstein2, John Curry2, Shannon Barnett2, Lisa Capasso2, Jamie Zelazny2, Jennifer Hughes2, Sa Shen2, S Sonia Gugga2, J Blake Turner2. 1. Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein and Ms. Zelazny are with the University of Pittsburgh, Western Psychiatric Institute & Clinic; Drs. Greenhill, Stanley, Posner, and Turner and Ms. Shen, Ms. Guggia, and Ms. Capasso are with the Columbia University-New York Psychiatric Institute; Drs. Emslie and Kennard and Ms. Hughes are with the University of Texas Southwestern Medical Center at Dallas; Drs. Wells, Compton, March, and Curry are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; and Drs. Walkup, Cwik, and Riddle and Ms. Barnett are with Johns Hopkins University. Electronic address: brentda@upmc.edu. 2. Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein and Ms. Zelazny are with the University of Pittsburgh, Western Psychiatric Institute & Clinic; Drs. Greenhill, Stanley, Posner, and Turner and Ms. Shen, Ms. Guggia, and Ms. Capasso are with the Columbia University-New York Psychiatric Institute; Drs. Emslie and Kennard and Ms. Hughes are with the University of Texas Southwestern Medical Center at Dallas; Drs. Wells, Compton, March, and Curry are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; and Drs. Walkup, Cwik, and Riddle and Ms. Barnett are with Johns Hopkins University.
Abstract
OBJECTIVE: To identify the predictors of suicidal events and attempts in adolescent suicide attempters with depression treated in an open treatment trial. METHOD: Adolescents who had made a recent suicide attempt and had unipolar depression (n =124) were either randomized (n = 22) or given a choice (n = 102) among three conditions. Two participants withdrew before treatment assignment. The remaining 124 youths received a specialized psychotherapy for suicide attempting adolescents (n = 17), a medication algorithm (n = 14), or the combination (n = 93). The participants were followed up 6 months after intake with respect to rate, timing, and predictors of a suicidal event (attempt or acute suicidal ideation necessitating emergency referral). RESULTS: The morbid risks of suicidal events and attempts on 6-month follow-up were 0.19 and 0.12, respectively, with a median time to event of 44 days. Higher self-rated depression, suicidal ideation, family income, greater number of previous suicide attempts, lower maximum lethality of previous attempt, history of sexual abuse, and lower family cohesion predicted the occurrence, and earlier time to event, with similar findings for the outcome of attempts. A slower decline in suicidal ideation was associated with the occurrence of a suicidal event. CONCLUSIONS: In this open trial, the 6-month morbid risks for suicidal events and for reattempts were lower than those in other comparable samples, suggesting that this intervention should be studied further. Important treatment targets include suicidal ideation, family cohesion, and sequelae of previous abuse. Because 40% of events occurred with 4 weeks of intake, an emphasis on safety planning and increased therapeutic contact early in treatment may be warranted.
RCT Entities:
OBJECTIVE: To identify the predictors of suicidal events and attempts in adolescent suicide attempters with depression treated in an open treatment trial. METHOD: Adolescents who had made a recent suicide attempt and had unipolar depression (n =124) were either randomized (n = 22) or given a choice (n = 102) among three conditions. Two participants withdrew before treatment assignment. The remaining 124 youths received a specialized psychotherapy for suicide attempting adolescents (n = 17), a medication algorithm (n = 14), or the combination (n = 93). The participants were followed up 6 months after intake with respect to rate, timing, and predictors of a suicidal event (attempt or acute suicidal ideation necessitating emergency referral). RESULTS: The morbid risks of suicidal events and attempts on 6-month follow-up were 0.19 and 0.12, respectively, with a median time to event of 44 days. Higher self-rated depression, suicidal ideation, family income, greater number of previous suicide attempts, lower maximum lethality of previous attempt, history of sexual abuse, and lower family cohesion predicted the occurrence, and earlier time to event, with similar findings for the outcome of attempts. A slower decline in suicidal ideation was associated with the occurrence of a suicidal event. CONCLUSIONS: In this open trial, the 6-month morbid risks for suicidal events and for reattempts were lower than those in other comparable samples, suggesting that this intervention should be studied further. Important treatment targets include suicidal ideation, family cohesion, and sequelae of previous abuse. Because 40% of events occurred with 4 weeks of intake, an emphasis on safety planning and increased therapeutic contact early in treatment may be warranted.
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