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Repeating a suicide attempt during adolescence: risk and protective factors 12 months after hospitalization

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Abstract

Suicide attempts (SAs) are a public health concern in adolescence. A brief hospitalization is recommended, but access to inpatient wards is often not available. In addition, numerous risk factors for SA recurrence have been identified, but few studies have explored protective factors. Here, we aimed to assess the role of both risk and protective factors on SA relapse in a context of free access to inpatient services. We performed a prospective follow-up study of 320 adolescents who were hospitalized for an SA between January 2011 and December 2014 in France. Assessments at baseline included socio-demographics, clinical characteristics, temperament, reasons for living, spirituality, and coping. Patients were re-evaluated at 6 months and 12 months for depression severity and SA relapse. A total of 135 and 91 patients (78 girls, 12 boys, aged 13–17) were followed up at 6 and 12 months, respectively. At the 12-month follow-up, 28 (30%) subjects had repeated an SA. Adolescents who either had a history of SA or were receiving psychotropic treatment at baseline were at higher risk of recurrence. Several variables had a protective effect: (1) productive coping skills, namely, working hard and achieving, physical recreation, and seeking relaxing diversions; (2) a particular temperament trait, namely, cooperativeness; and (3) having experienced more life events. We also found a significant interaction: the higher the depression score during follow-up, the lower the protective effect of productive coping. Our findings confirm that a history of SA and seeking psychiatric care with medication are risk factors for SA relapse. However, productive coping strategies and cooperativeness are protective factors, and the improvement of such strategies as well as treatment of persisting depression should be a goal of psychotherapy treatment offered to suicidal adolescents.

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References

  1. 1.

    World Health Organization (2017) World Health Statistics 2016. World Health Organization, Geneva. http://www.who.int/gho/publications/world_health_statistics/2016/en/. Accessed 1 July 2019

  2. 2.

    Hawton K, van Heeringen K (2009) Suicide. Lancet 373:1372–1381

  3. 3.

    Brent DA, Bridge J, Johnson BA, Connolly J (1996) Suicidal behavior runs in families. A controlled family study of adolescent suicide victims. Arch Gen Psychiatry 53:1145–1152

  4. 4.

    Hulten A, Jiang GX, Wasserman D et al (2001) Repetition of attempted suicide among teenagers in Europe: frequency, timing and risk factors. Eur Child Adolesc Psychiatry 10(3):161–169

  5. 5.

    Goldacre M, Hawton K (1985) Repetition of self-poisoning and subsequent death in adolescents who take overdoses. Br J Psychiatry 146:395–408

  6. 6.

    Brent DA, Kolko DJ, Wartella ME et al (1993) Adolescent psychiatric inpatients’ risk of suicide attempt at 6-month follow-up. J Am Acad Child Adolesc Psychiatry 32:95–105. https://doi.org/10.1097/00004583-199301000-00015

  7. 7.

    Pfeffer CR, Klerman GL, Hurt SW et al (1993) Suicidal children grow up: rates and psychosocial risk factors for suicide attempts during follow-up. J Am Acad Child Adolesc Psychiatry 32:106–113

  8. 8.

    Garland AF, Zigler E (1993) Adolescent suicide prevention: current research and policy implications. Am Psychol 48:169–182

  9. 9.

    Breton J-J, Labelle R, Berthiaume C et al (2015) Protective factors against depression and suicidal behaviour in adolescence. Can J Psychiatry 60:S5–S15

  10. 10.

    Kraemer HC, Stice E, Kazdin A et al (2001) How do risk factors work together? Mediators, moderators and independent, overlapping and proxy risk factors. Am J Psychiatry 158:848–856

  11. 11.

    Brezo J, Paris J, Vitaro F et al (2008) Predicting suicide attempts in young adults with histories of childhood abuse. Br J Psychiatry 193:134–139. https://doi.org/10.1192/bjp.bp.107.037994

  12. 12.

    Consoli A, Peyre H, Speranza M et al (2013) Suicidal behaviors in depressed adolescents: role of perceived relationships in the family. Child Adolesc Psychiatry Ment Health 7:8. https://doi.org/10.1186/1753-2000-7-8

  13. 13.

    Mann JJ (2013) The serotonergic system in mood disorders and suicidal behaviour. Philos Trans R Soc Lond B Biol Sci 368:20120537. https://doi.org/10.1098/rstb.2012.0537

  14. 14.

    McGirr A, Diaconu G, Berlim MT et al (2010) Dysregulation of the sympathetic nervous system, hypothalamic-pituitary-adrenal axis and executive function in individuals at risk for suicide. J Psychiatry Neurosci 35:399–408. https://doi.org/10.1503/jpn.090121

  15. 15.

    da Silva AG, Malloy-Diniz LF, Garcia MS et al (2018) Cognition as a therapeutic target in the suicidal patient approach. Front Psychiatry 9:31. https://doi.org/10.3389/fpsyt.2018.00031

  16. 16.

    King CA, Merchant CR (2008) Social and interpersonal factors relating to adolescent suicidality: a review of the literature. Arch Suicide Res 12:181–196. https://doi.org/10.1080/13811110802101203

  17. 17.

    Mustanski B, Liu RT (2013) A longitudinal study of predictors of suicide attempts among lesbian, gay, bisexual, and transgender youth. Arch Sex Behav 42:437–448. https://doi.org/10.1007/s10508-012-0013-9

  18. 18.

    Tuisku V, Kiviruusu O, Pelkonen M et al (2014) Depressed adolescents as young adults—predictors of suicide attempt and non-suicidal self-injury during an 8-year follow-up. J Affect Disord 152–154:313–319. https://doi.org/10.1016/j.jad.2013.09.031

  19. 19.

    King CA, Segal H, Kaminski K et al (1995) A prospective study of adolescent suicidal behavior following hospitalization. Suicide Life Threat Behav 25:327–338

  20. 20.

    Renaud J, Berlim MT, McGirr A et al (2008) Current psychiatric morbidity, aggression/impulsivity, and personality dimensions in child and adolescent suicide: a case-control study. J Affect Disord 105:221–228. https://doi.org/10.1016/j.jad.2007.05.013

  21. 21.

    Halfon N, Labelle R, Cohen D et al (2013) Juvenile bipolar disorder and suicidality: a review of the last 10 years of literature. Eur Child Adolesc Psychiatry 22:139–151. https://doi.org/10.1007/s00787-012-0328-z

  22. 22.

    Prinstein MJ, Nock MK, Simon V et al (2008) Longitudinal trajectories and predictors of adolescent suicidal ideation and attempts following inpatient hospitalization. J Consult Clin Psychol 76:92–103. https://doi.org/10.1037/0022-006X.76.1.92

  23. 23.

    Brent DA, Greenhill LL, Compton S et al (2009) The treatment of adolescent suicide attempters study (TASA): predictors of suicidal events in an open treatment trial. J Am Acad Child Adolesc Psychiatry 48:987–996. https://doi.org/10.1097/CHI.0b013e3181b5dbe4

  24. 24.

    King CA, Kerr DCR, Passarelli MN et al (2010) One-year follow-up of suicidal adolescents: parental history of mental health problems and time to post-hospitalization attempt. J Youth Adolesc 39:219–232. https://doi.org/10.1007/s10964-009-9480-2

  25. 25.

    Goodman M, Tomas IA, Temes CM et al (2017) Suicide attempts and self-injurious behaviours in adolescent and adult patients with borderline personality disorder. Personal Ment Health 11:157–163. https://doi.org/10.1002/pmh.1375

  26. 26.

    Bridge JA, Goldstein TR, Brent DA (2006) Adolescent suicide and suicidal behavior. J Child Psychol Psychiatry 47:372–394. https://doi.org/10.1111/j.1469-7610.2006.01615.x

  27. 27.

    Spirito A, Valeri S, Boergers J, Donaldson D (2003) Predictors of continued suicidal behavior in adolescents following a suicide attempt. J Clin Child Adolesc Psychol 32:284–289. https://doi.org/10.1207/S15374424JCCP3202_14

  28. 28.

    Consoli A, Cohen D, Bodeau N et al (2015) Risk and protective factors for suicidality at 6-month follow-up in adolescent inpatients who attempted suicide: an exploratory model. Can J Psychiatry 60:S27–S36

  29. 29.

    Yen S, Weinstock LM, Andover MS et al (2013) Prospective predictors of adolescent suicidality: 6-month post-hospitalization follow-up. Psychol Med 43:983–993

  30. 30.

    Goldston DB, Daniel SS, Reboussin DM et al (1999) Suicide attempts among formerly hospitalized adolescents: a prospective naturalistic study of risk during the first 5 years after discharge. J Am Acad Child Adolesc Psychiatry 38:660–671. https://doi.org/10.1097/00004583-199906000-00012

  31. 31.

    Laurent A, Foussard N, David M et al (1998) A 5-year follow-up study of suicide attempts among French adolescents. J Adolesc Health 22:424–430. https://doi.org/10.1017/s0033291712001912

  32. 32.

    Miranda R, De Jaegere E, Restifo K, Shaffer D (2014) Longitudinal follow-up study of adolescents who report a suicide attempt: aspects of suicidal behavior that increase risk of a future attempt. Depress Anxiety 31:19–26. https://doi.org/10.1002/da.22194

  33. 33.

    Nrugham L, Holen A, Sund AM (2012) Suicide attempters and repeaters: depression and coping: a prospective study of early adolescents followed up as young adults. J Nerv Ment Dis 200:197–203. https://doi.org/10.1097/NMD.0b013e318247c914

  34. 34.

    Mirkovic B, Labelle R, Guile J-M et al (2015) Coping skills among adolescent suicide attempters: results of a multisite study. Can J Psychiatry 60:S37–S45

  35. 35.

    Gutierrez PM, Osman A, Kopper BA, Barrios FX (2000) Why young people do not kill themselves: the reasons for living inventory for adolescents. J Clin Child Psychol 29:177–187. https://doi.org/10.1207/S15374424jccp2902_4

  36. 36.

    Hollingsworth DW, Slish ML, Wingate LR et al (2018) The indirect effect of perceived burdensomeness on the relationship between indices of social support and suicide ideation in college students. J Am Coll Health 66:9–16. https://doi.org/10.1080/07448481.2017.1363764

  37. 37.

    Benarous X, Milhiet V, Oppetit A et al (2019) Changes in the use of emergency care for the youth with mental health problems over decades: a repeated cross sectional study. Front Psychiatry 10:26. https://doi.org/10.3389/fpsyt.2019.00026

  38. 38.

    NICE: Self-Harm: The Short-Term Physical and Psychological Management and Secondary Prevention of Self-Harm in Primary and Secondary Care (2004) The British Psychological Society and The Royal College of Psychiatrists. https://www.ncbi.nlm.nih.gov/books/NBK56406/

  39. 39.

    ANAES (1998) Prise en charge hospitalière des adolescents après une tentative de suicide. Saint-Denis, France

  40. 40.

    Kaufman J, Birmaher B, Brent D et al (1997) Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 36:980–988. https://doi.org/10.1097/00004583-199707000-00021. Accessed 1 July 2019

  41. 41.

    Beck AT, Steer RA, Brown GK (1996) Manual for the beck depression inventory. Psychological Corporation, San Antonio

  42. 42.

    Posner K, Oquendo MA, Gould M et al (2007) Columbia Classification Algorithm of Suicide Assessment (C-CASA): classification of suicidal events in the FDA’s pediatric suicidal risk analysis of antidepressants. Am J Psychiatry 164:1035–1043. https://doi.org/10.1176/ajp.2007.164.7.1035

  43. 43.

    Beck AT, Steer RA (1996) Manual for the Beck Hopelessness Scale. Psychological Corporation, San Antonio

  44. 44.

    Guile JM, Greenfield B, Berthiaume C et al (2009) Reliability and diagnostic efficiency of the abbreviated-diagnostic interview for borderlines in an adolescent clinical population. Eur Child Adolesc Psychiatry 18:575–581. https://doi.org/10.1007/s00787-009-0015-x

  45. 45.

    Eysenck HJ, Eysenck SBG (1975) Manual of the Eysenck personality questionnaire (junior and adult). Hodder and Stoughton, London

  46. 46.

    Newcomb MD, Huber GJ, Bentler PM (1981) A multidimensional assessement of stressful life events among adolescents. J Health Soc Behav 22:400–415

  47. 47.

    Landry M, Trembaly J, Guyon L (2004) DEP-ADO Grille de dépistage de consommation problématique d’alcool et de drogues chez les adolescents et les adolescentes. Drogues Santé et Sociétés 3(1):19–37

  48. 48.

    Rosenberg M (1965) Society and adolescent self-image. Princeton University Press, Princeton

  49. 49.

    Griffin D, Bartholomew K (1994) Models of the self and other: fundamental dimensions underlying measures of adult attachment. J Pers Soc Psychol 67:430–445

  50. 50.

    Rigozzi C, Rossier J (2004) Validation d’une version abrégée du TCI (TCI-56) sur un échantillon de jeunes fumeurs. Annales médico-psychologiques 162:541–548

  51. 51.

    Cloninger CR (1994) Temperament and personality. Curr Opin Neurobiol 4:266–273

  52. 52.

    Osman A, Downs WR, Kopper BA et al (1998) The Reasons for Living Inventory for Adolescents (RFL-A): development and psychometric properties. J Clin Psychol 54:1063–1078

  53. 53.

    Labelle R, Daigle MS, Pronovost J, Marcotte D (1998) Étude psychométrique d’une version française du “Suicide Probability Scale” auprès de trois populations distinctes. Psychologie et psychométrie 19:5–26

  54. 54.

    Labelle R, Breton J-J, Berthiaume C et al (2015) Psychometric properties of three measures of protective factors for depression and suicidal behaviour among adolescents. Can J Psychiatry 60:S16–S26

  55. 55.

    Delaney C (2005) The Spirituality Scale: development and psychometric testing of a holistic instrument to assess the human spiritual dimension. J Holist Nurs 23:145–67; discussion 168–171. https://doi.org/10.1177/0898010105276180

  56. 56.

    Frydenberg E (1993) The Adolescent Coping Scale. Australian Council for Educational Research, Melbourne

  57. 57.

    Leclerc D, Pronovost J, Dumont M (2009) Echelle de coping pour adolescent: validation canadienne-française de l’Adolescent Coping Scale de Frydenberg et Lewis (1993). Revue québécoise de psychologie 30(1):177–196

  58. 58.

    SPSS SPSS Inc. Released (2008) SPSS Statistics for Windows, Version 17.0. SPSS Inc., Chicago

  59. 59.

    Flament MF, Cohen D, Choquet M, Jeammet P, Ledoux S (2001) Phenomenology, psychosocial correlates, and treatment seeking in major depression and dysthymia of adolescence. J Am Acad Child Adolesc Psychiatry 40(9):1070–1078

  60. 60.

    Orozco R, Benjet C, Borges G, Moneta Arce MF, Fregoso Ito D, Fleiz C, Villatoro JA (2018) Association between attempted suicide and academic performance indicators among middle and high school students in Mexico: results from a national survey. Child Adolesc Psychiatry Ment Health 12:9

  61. 61.

    McMahon EM, Corcoran P, Keeley H et al (2017) Mental health difficulties and suicidal behaviours among young migrants: multicentre study of European adolescents. BJPsych Open 3:291–299. https://doi.org/10.1192/bjpo.bp.117.005322

  62. 62.

    Tschan T, Peter-Ruf C, Schmid M, In-Albon T (2017) Temperament and character traits in female adolescents with nonsuicidal self-injury disorder with and without comorbid borderline personality disorder. Child Adolesc Psychiatry Ment Health 11:4

  63. 63.

    Garcia D, Lundstrom S, Brandstrom S et al (2013) Temperament and character in the Child and Adolescent Twin Study in Sweden (CATSS): comparison to the general population, and genetic structure analysis. PLoS ONE 8:e70475. https://doi.org/10.1371/journal.pone.0070475

  64. 64.

    Dworkin ER (2018) Risk for mental disorders associated with sexual assault: a meta-analysis. Trauma Violence Abuse. https://doi.org/10.1177/1524838018813198

  65. 65.

    Newcomb MD, Huba GJ, Bentler PM (1986) Life change events among adolescents. An empirical consideration of some methodological issues. J Nerv Ment Dis 174:280–289

  66. 66.

    Paul E (2018) Proximally-occurring life events and the first transition from suicidal ideation to suicide attempt in adolescents. J Affect Disord 241:499–504. https://doi.org/10.1016/j.jad.2018.08.059

  67. 67.

    Schrijvers DL, Bollen J, Sabbe BGC (2001) The gender paradox in suicidal behavior and its impact on the suicidal process. J Affect Disord 138(1–2):19–26

  68. 68.

    Rhodes AE, Boyle MH, Bridge JA et al (2014) Antecedents and sex/gender differences in youth suicidal behavior. World J Psychiatry 4(4):120–132

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Acknowledgements

We would like to acknowledge Rouen University Hospital, Rouvray Hospital, Pfizer Foundation, Fondation de France, and the Commission Permanente de Coopération Franco-Québécoise for supporting this project. We would also like to thank the research collaborators and all interviewees for their unique contribution to the study.

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Correspondence to Bojan Mirkovic.

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Mirkovic, B., Cohen, D., Garny de la Rivière, S. et al. Repeating a suicide attempt during adolescence: risk and protective factors 12 months after hospitalization. Eur Child Adolesc Psychiatry (2020). https://doi.org/10.1007/s00787-020-01491-x

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Keywords

  • Suicide attempt
  • Suicidal behaviour
  • Cohort study
  • Adolescent
  • Protective factor
  • Coping