Suicidality, function and associated negative life events in an adolescent psychiatric population at 3-year follow-up

Abstract

Background We aimed to examine psychosocial function, suicidality and school dropout in a clinical psychiatric population over a 3-year period from adolescence to young adulthood and explore associations with negative life events. Methods This study is part of the Health Survey in Department of Children and Youth, St. Olavs hospital, Norway. In the first study visit (T1), 717 (43.5% of eligible) participated, aged 13–18 years (2009–2011), and 3 years later (T2), 570 answered a questionnaire (school functioning and negative life events), and 549 completed Kiddie SADS as telephone interview assessing DSM-IV diagnoses, psychosocial functioning and suicidality. Results Suicidal ideation was more frequent among girls (17.9%) than among boys (5.4%) (risk difference; RD = 12.5%, CI (7.2 to 17.7), p < 0.001), as was suicidal behavior (25.0% vs. 9.5%, RD = 15.5%, CI (9.2 to 21.4), p < 0.001). Girls had lower psychosocial functioning than boys (Children’s Global Assessment Scale; Mean score 68.2 vs. 75.2, Mean difference = − 7.0, CI (− 9.4 to − 4.7), p < 0.001), and more school dropout (22.5% vs. 13.2%, RD = 9.3%, CI (2.8 to 15.5), p = 0.006). For those with a psychiatric disorder, 24.8% of girls had suicidal ideation and 30.0% suicidal behavior, which was larger than for boys (RD = 18.0%, CI (10.8 to 24.7), p < 0.001, and RD = 18.3%, CI (10.2 to 25.8), p < 0.001, respectively). Exposure to negative life events was frequent for both genders, but more girls had experienced sexually uncomfortable or abusive situations, the last 3 years (23.5% vs. 2.9%, RD = 20.6%, CI (15.4 to 25.7), p < 0.001), and ever (44.4% vs. 7.9%, RD = 36.5%, CI (29.9 to 42.7), p < 0.001). Suicidal behavior was associated with having been threatened, physically harassed or violently hurt (RD = 16.7%, CI (9.5 to 23.9), p < 0.001), and for girls been put into sexually uncomfortable or abusive situations (RD = 20.1%, CI (10.4 to 29.9), p < 0.001) and seen others violently hurt (RD = 14.6%, CI (3.4 to 25.8), p = 0.011). Conclusions The high frequency of suicidality and school dropout confirms the severity of adolescent psychiatric disorders, especially among girls. Specific life events were associated risk factors and should be target points for prevention and intervention.

Correlates of suicidality in young people with depressive disorders: A systematic review

“…The typical follow-up period across theses 12 studies was 1 year, while the maximum period was 8 years (Tuisku et al, 2014). Across these prospective studies, the most commonly reported correlates were sex (female) (Gårdvik et al, 2021; Tuisku et al, 2012), depression type (unipolar) (Lewinsohn et al, 2001; Nrugham et al, 2008), depression severity (Tuisku et al, 2012, 2014), comorbid anxiety disorders (Lippard et al, 2019; Nelson et al, 2000), alcohol consumption (non-SUD) (Tuisku et al, 2012, 2014) and NSSI (Tuisku et al, 2012, 2014). The following correlates were reported to be statistically associated with suicidality in a single prospective study each (details provided in Table 3): age, depression frequency/recurrence, psychomotor features, personality disorders, SUDs, general psychiatric comorbidity, extraversion, sleep disruption, social support and neurological characteristics.…”

“…Three studies (4%) (Fan et al, 2019; Johnston et al, 2017; Lippard et al, 2019) did not provide details of the study setting; these were all neuroimaging studies. Of the studies conducted in clinical settings, 17 exclusively involved outpatient settings (Csorba et al, 2010a, 2010b; Fonseka et al, 2015; Gårdvik et al, 2021; Gulec et al, 2010; Janiri et al, 2021; Kutcher et al, 1990; MacPherson et al, 2021; Moller et al, 2021; Rudd et al, 1993; Smith et al, 2005; Spalletta et al, 1996; Tuisku et al, 2006, 2012, 2014; Urrila et al, 2014; Yule et al, 2018), 13 exclusively involved inpatient settings (Barrash et al, 1993; Beautrais et al, 1998; Deykin and Buka, 1994; Gabbay et al, 2009; Gmitrowicz and Kołodziej-Meciejewska, 2002; Hong et al, 2021; Méan et al, 2005; Patten et al, 2003; Righini et al, 2005; Salazar de Pablo et al, 2020; Sher et al, 2007; Shoval et al, 2006; Zhu et al, 2021) and 7 involved both outpatient and inpatient settings (Beglyankin et al, 2019; Gibbons, 2007; Joiner et al, 2009; Koeda et al, 2012; Rudd et al, 1996; Seo et al, 2015; Zhang et al, 2016) (one of the latter also included community participants). Studies conducted in community settings were defined as those which were not explicitly inpatient or outpatient settings, and those that did not explicitly target participants who were receiving either outpatient or inpatient medical or mental health treatment.…”

“…While the quality of reporting across studies was highly variable, all studies were included in the review, regardless of the outcome of the critical appraisal process. Only six studies (Deykin and Buka, 1994; Gårdvik et al, 2021; MacPherson et al, 2021; Moller et al, 2021; Tuisku et al, 2006, 2014) satisfied criteria for all eight core critical appraisal checklist items. Over half (58%; n = 41) of the studies satisfied five or more of these core criteria.…”

Psychosocial risk factors associated with suicide in youth and adolescents: A systematic review

“…Additionally, the psychopathological component was found as a factor related to suicide, showing the risk that people with mental disorders have; especially depressive disorders, anxiety disorders, psychotic disorders, personality disorders, and Attention Deficit Hyperactivity Disorder (ADHD) (86,87,92,94). In the same way, several authors agree on how the cognitive component is important in this problem since it is recognized in the studies that it is more likely that the suicidal act is carried out when there is the presence of ideas related to death, as well as when there is a history of suffering from mental illnesses (19,87).…”

Risk and protective factors for self-harm and suicide in children and adolescents: a systematic review and meta-analysis protocol

“…Pre-existing externalising (eg, conduct problems) and internalising symptoms (eg, depression or anxiety) of psychopathology have been demonstrated to be significant risk factors for suicidal behaviour 14 15. Other risk factors include: sociodemographic factors, such as age,16 gender, sexual orientation, transgender status and socioeconomic status17 18; stressful life events, most notably, childhood abuse19 20; familial factors, including familial psychopathology, family dysfunction, family conflict and perceived parental support21–26; school-related factors such as academic performance and school attendance27 28; biological factors such as genetic predisposition, changes in brain structure and function, and inflammatory status29–31; and social factors including peer relatedness, bullying perpetration and victimisation, and social media use 16 26 32–36. Some studies have examined the relationship between self-harm or suicidal behaviour and specific emotions, such as hopefulness and self-esteem and emotional lability 16 34 37 38…”