Adolescent Suicide Attempts and Adult Adjustment

Abstract

Background Adolescent suicide attempts are disproportionally prevalent and frequently of low severity, raising questions regarding their long-term prognostic implications. In this study, we examined whether adolescent attempts were associated with impairments related to suicidality, psychopathology, and psychosocial functioning in adulthood (objective 1) and whether these impairments were better accounted for by concurrent adolescent confounders (objective 2). Method 816 adolescents were assessed using interviews and questionnaires at four time points from adolescence to adulthood. We examined whether lifetime suicide attempts in adolescence (by T2, mean age 17) predicted adult outcomes (by T4, mean age 30) using linear and logistic regressions in unadjusted models (objective 1) and adjusting for sociodemographic background, adolescent psychopathology, and family risk factors (objective 2). Results In unadjusted analyses, adolescent suicide attempts predicted poorer adjustment on all outcomes, except those related to social role status. After adjustment, adolescent attempts remained predictive of axis I and II psychopathology (anxiety disorder, antisocial and borderline personality disorder symptoms), global and social adjustment, risky sex, and psychiatric treatment utilization. However, adolescent attempts no longer predicted most adult outcomes, notably suicide attempts and major depressive disorder. Secondary analyses indicated that associations did not differ by sex and attempt characteristics (intent, lethality, recurrence). Conclusions Adolescent suicide attempters are at high risk of protracted and wide-ranging impairments, regardless of the characteristics of their attempt. Although attempts specifically predict (and possibly influence) several outcomes, results suggest that most impairments reflect the confounding contributions of other individual and family problems or vulnerabilites in adolescent attempters.

Prognosis and Psychosocial Outcomes of Attempted Suicide by Early Adolescence

“…Therefore, this finding of depressive disorders being one of the outcomes associated with an early adolescent suicidal act needs to be interpreted with caution. It is also to be noted that the Oregon Adolescent Depression Project did not find such an outcome when its adolescents were followed up at age 30 years (Brière et al, 2014).…”

“…However, this longitudinal prospective study did not particularly assess the outcomes of those age groups with the highest percentage of suicidal acts: those in early adolescence aged between 14 and 15 years. When followed up at age 30 years, adolescent suicide attempts did not predict repeated attempts or major depressive disorder (MDD; Brière et al, 2014). However, in another longitudinal prospective study, suicidal ideation and major depression between ages 18 and 25 years were the outcomes associated with suicide attempts made by age 18 years among community adolescents; for the women, two additional outcomes were found: substance abuse and later suicidal acts (Fergusson et al, 2005b).…”

“…R esearch on adolescent suicidal behavior has focused mainly on risk factors, less on outcomes (Bridge et al, 2006;Brière et al, 2014) or prognosis, despite the clear clinical relevance and policy implications of such knowledge (Fergusson et al, 2005a). The most common cause of death among adolescent girls aged 15 to 19 years is suicide (Patton et al, 2009); however, more male adolescents die by suicide (Hawton et al, 2012).…”

“…Hence, a worse prognosis was expected among adolescents who started suicidal behavior earlier than those who started such acts during middle adolescence, that is, between ages 14 and 15 years. We expected that negative outcomes would be reflected in both psychiatric and psychosocial aspects of their lives (Brière et al, 2014). Despite its clear clinical relevance, whether adolescents who are early starters and repeaters of suicidal acts differ on outcomes in adulthood from those with a single attempt has not yet been reported.…”

The Impact of Anxiety Sensitivity on Suicidality in Adolescents With Major Depressive Disorder

“…Some studies have supported this opinion by observing the importance of the anxiety disorders in suicide risk. For instance, Brière et al (2015) observed that adolescent suicide attempts were predictive of anxiety disorders but not depression in adults. Beghi et al (2010) indicated the increased risk of anxiety disorders in adolescents who had suicidal self-harm above and beyond depression.…”