Five Profiles of Adolescents at Elevated Risk for Suicide Attempts: Differences in Mental Health Service Use

Abstract

Objective: Adolescents at risk for suicide are highly heterogeneous in terms of psychiatric and social risk factors, yet there has been little systematic research on risk profiles, which would facilitate recognition and the matching of patients to services. Our primary study aims were to identify latent class profiles of adolescents with elevated suicide risk, and to examine the association of these profiles with mental health service use (MHSU). Method: Participants were 1,609 adolescents from the Emergency Department Screen for Teens at Risk for Suicide (ED-STARS) cohort. Participants completed baseline surveys assessing demographics, MHSU, and suicide risk. Telephone follow-up interviews were conducted at 3 months to assess suicide attempts. Participants met pre-established baseline criteria for suicide risk. Results: Using latent class analysis, we derived 5 profiles of elevated suicide risk with differing patterns of eight risk factors: history of multiple suicide attempts, past-month suicidal ideation, depression, alcohol and drug misuse, impulsive-aggression, and sexual and physical abuse. In comparison to adolescents who did not meet baseline criteria for suicide risk, each profile was associated with increased risk of a suicide attempt within 3 months. The MHSU was lowest for adolescents fitting profiles with previous (but no recent) suicidal thoughts and behavior, and for adolescents from racial and ethnic minority groups. Conclusion: Adolescents at elevated risk for suicide present to emergency departments with differing profiles of suicide risk. MHSU varies across these profiles and by race/ethnicity, indicating that targeted risk recognition and treatment linkage efforts may be necessary to reach some adolescents at risk.

Suicidal Behavior in Adolescents: A Latent Class Analysis

“…These findings closely match those of previous studies using the LC approach in both adolescent and adult populations [23][24][25][27][28][29]54]. Previous studies show an empirically derived classification that partially coincides with the present study [32,35,36,55]. For instance, King et al [35] identified five profiles of adolescents based on their past history of suicide attempts, suicide ideations endorsed in the past month, depression, alcohol and drug use, aggressive impulses, and past history of physical and/or sexual abuse.…”

“…Previous studies show an empirically derived classification that partially coincides with the present study [32,35,36,55]. For instance, King et al [35] identified five profiles of adolescents based on their past history of suicide attempts, suicide ideations endorsed in the past month, depression, alcohol and drug use, aggressive impulses, and past history of physical and/or sexual abuse. Although the number of groups were different to that of the present work, the authors found four groups of individuals on the basis of the suicide attempts (acts), suicide ideation, and the risk of suicide when considering the association between suicidal behavior and other related variables.…”

“…For example, Jung et al [55] developed a study in which three latent profiles were identified as a function of internalizing and externalizing problems. Similarly, studies using an LCA approach showed a relationship between the risk of suicide and other variables related to lifestyle, such as pattern of sleep, physical exercise, and drug use [2,[32][33][34][35]. The results revealed that health-promoting behaviors, a regular diet, and moderate exercise had a protective impact on adolescents' suicidal behaviors by decreasing the ultimate suicide risk [33].…”

“…At present, there are several studies that examined the heterogeneity among individuals with varying histories of suicidal behavior [9,24,[30][31][32][33]. Mixture modelling has been employed in adolescent populations [32][33][34][35][36]. For instance, Jiang et al [32] identified four groupings for a representative sample of adolescents: (1) emotionally healthy, (2) considered and planned suicide, (3) attempted suicide and (4) planned and attempted suicide.…”

Contraception Provision in the Emergency Department: Are We Ready to Overcome the Obstacles?

“…19 Furthermore, in a national study, sex without contraceptives among teens aged 13-17 years was associated with other high-risk behaviors, such as binge drinking, depression, and conduct disorder. 20 Given the number of high-risk adolescents seen in pediatric EDs, it forces us to wonder if the ED should be a point of access to hormonal contraception.…”