Frank Iorfino1, Daniel F Hermens2, Shane P M Cross3, Natalia Zmicerevska3, Alissa Nichles3, Josine Groot3, Adam J Guastella3, Elizabeth M Scott3, Ian B Hickie3. 1. Brain and Mind Centre, University of Sydney, 94 Mallet Street, Camperdown, Sydney, NSW, Australia. Electronic address: frank.iorfino@sydney.edu.au. 2. Brain and Mind Centre, University of Sydney, 94 Mallet Street, Camperdown, Sydney, NSW, Australia; Sunshine Coast Mind and Neuroscience Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia. 3. Brain and Mind Centre, University of Sydney, 94 Mallet Street, Camperdown, Sydney, NSW, Australia.
Abstract
BACKGROUND: Mental disorders and suicidal thoughts and behaviours are common in help-seeking youth. Few studies report the longitudinal associations between these phenomena and clinical and functional outcomes. This study examined whether prior suicide attempts predict poorer outcomes in mental health service attendees. METHODS: Clinical and functional data from 1143 individuals (aged 12-30) attending a primary care-based mental health service in Australia were collected over 3-60 months (median = 21 months). Odds ratios (OR) with 95% confidence intervals for the effect of a prior suicide attempt on follow-up outcomes were estimated (adjusted for confounders). RESULTS: Prior suicide attempts were common (n = 164; 14%) and prospectively associated with suicidal thoughts (OR = 1.71), suicide attempts (OR = 2.59), self-harm (OR = 1.71), an increased likelihood of being diagnosed with bipolar disorder (OR = 2.99), and the onset of an alcohol/substance use disorder (OR = 2.87). Over the course of care, no suicide attempts were reported in 1052 (92%) individuals, but 25 (2%) had recurrent attempts, and 66 (6%) had new onset of an attempt. New onset was associated with being female and previous suicidal ideation or self-harm; recurrent attempts were associated with being older and comorbid alcohol/substance use disorder. LIMITATIONS: The cohort includes only individuals who remained in clinical contact, and the consistency of their documentation varied (across clinicians and over time). CONCLUSIONS: Young people with prior suicide attempts are vulnerable to ongoing suicidal behaviours, and poorer clinical and functional outcomes. More intensive management strategies may be needed to directly address these behaviours and the long-term risks they confer. These behaviours also emerge over the course of care among those with no previous history, which has important implications for active service-level strategies that target these behaviours for all of those who present to such services.
BACKGROUND:Mental disorders and suicidal thoughts and behaviours are common in help-seeking youth. Few studies report the longitudinal associations between these phenomena and clinical and functional outcomes. This study examined whether prior suicide attempts predict poorer outcomes in mental health service attendees. METHODS: Clinical and functional data from 1143 individuals (aged 12-30) attending a primary care-based mental health service in Australia were collected over 3-60 months (median = 21 months). Odds ratios (OR) with 95% confidence intervals for the effect of a prior suicide attempt on follow-up outcomes were estimated (adjusted for confounders). RESULTS: Prior suicide attempts were common (n = 164; 14%) and prospectively associated with suicidal thoughts (OR = 1.71), suicide attempts (OR = 2.59), self-harm (OR = 1.71), an increased likelihood of being diagnosed with bipolar disorder (OR = 2.99), and the onset of an alcohol/substance use disorder (OR = 2.87). Over the course of care, no suicide attempts were reported in 1052 (92%) individuals, but 25 (2%) had recurrent attempts, and 66 (6%) had new onset of an attempt. New onset was associated with being female and previous suicidal ideation or self-harm; recurrent attempts were associated with being older and comorbid alcohol/substance use disorder. LIMITATIONS: The cohort includes only individuals who remained in clinical contact, and the consistency of their documentation varied (across clinicians and over time). CONCLUSIONS: Young people with prior suicide attempts are vulnerable to ongoing suicidal behaviours, and poorer clinical and functional outcomes. More intensive management strategies may be needed to directly address these behaviours and the long-term risks they confer. These behaviours also emerge over the course of care among those with no previous history, which has important implications for active service-level strategies that target these behaviours for all of those who present to such services.
Authors: Jacob J Crouse; Kate M Chitty; Frank Iorfino; Django White; Alissa Nichles; Natalia Zmicerevska; Adam J Guastella; Ahmed A Moustafa; Daniel F Hermens; Elizabeth M Scott; Ian B Hickie Journal: PLoS One Date: 2019-01-17 Impact factor: 3.240
Authors: Frank Iorfino; Nicholas Ho; Joanne S Carpenter; Shane P Cross; Tracey A Davenport; Daniel F Hermens; Hannah Yee; Alissa Nichles; Natalia Zmicerevska; Adam Guastella; Elizabeth Scott; Ian B Hickie Journal: PLoS One Date: 2020-12-31 Impact factor: 3.240
Authors: Catherine McHugh; Yun Ju Christine Song; Natalia Zmicerevska; Jacob Crouse; Alissa Nichles; Chloe Wilson; Nicholas Ho; Frank Iorfino; Adam Skinner; Elizabeth M Scott; Ian B Hickie Journal: BMJ Open Date: 2022-02-21 Impact factor: 2.692
Authors: Joanne S Carpenter; Frank Iorfino; Shane Cross; Alissa Nichles; Natalia Zmicerevska; Jacob J Crouse; Jake R Palmer; Alexis E Whitton; Django White; Sharon L Naismith; Adam J Guastella; Daniel F Hermens; Jan Scott; Elizabeth M Scott; Ian B Hickie Journal: BMJ Open Date: 2020-03-29 Impact factor: 2.692