Characteristics of Child Psychiatric Outpatients at Highest Risk for Suicidal Thoughts and Behaviors

  • Pieter J. Vuijk
  • Hillary H. Bush
  • Patrick S. McGuinness
  • Sheila M. O’Keefe
  • Brenda A. Lee
  • Hillary L. Ditmars
  • Anna R. Samkavitz
  • Hannah S. Lind
  • Ellen B. Braaten
  • Alysa E. DoyleEmail author
Original Article


On average, compared to non-referred youth, child psychiatric outpatients show elevated rates of suicidal thoughts and behaviors (STBs), which are predictors of completed suicide. Determining the psychopathology features that associate with highest risk for STBs among youth outpatients may yield opportunities for targeted prevention/intervention. Yet, outpatient studies are limited and have not systematically examined comorbidity and dimensional psychopathology. In 758 youth, aged 6–18, consecutively referred for neuropsychiatric evaluation, we examined the extent to which diagnostic groups, comorbid subgroups and dimensional symptoms associated with STBs. After controlling for comorbidity, mood, anxiety and conduct disorders associated with elevated STB risk. Regarding dimensions, symptoms of depression, aggression and psychosis all contributed to higher STB risk. Although ADHD (as a diagnosis or dimension) did not associate with elevated STB risk independently, ADHD that was comorbid with other conditions did. Suicide prevention/intervention efforts should be investigated in youth outpatients with the highest risk for STBs.


Children Outpatients Suicidal thoughts and behaviors Comorbidity Symptom dimensions 



This research was supported by funding from the David Judah Foundation and the Stanley Center for Psychiatric Research to AD.

Compliance with Ethical Standards

Conflict of interest

The authors report no conflicts of interest or relationships that are likely to have created bias in relation to this work.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Research Involving Human and Animal Participants

This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Pieter J. Vuijk
    • 1
  • Hillary H. Bush
    • 2
    • 3
  • Patrick S. McGuinness
    • 2
  • Sheila M. O’Keefe
    • 2
    • 3
  • Brenda A. Lee
    • 1
  • Hillary L. Ditmars
    • 1
  • Anna R. Samkavitz
    • 1
  • Hannah S. Lind
    • 1
  • Ellen B. Braaten
    • 2
    • 3
  • Alysa E. Doyle
    • 1
    • 2
    • 3
    • 4
    Email author
  1. 1.Center for Genomic MedicineMassachusetts General HospitalBostonUSA
  2. 2.Department of PsychiatryMassachusetts General HospitalBostonUSA
  3. 3.Harvard Medical SchoolMassachusetts General HospitalBostonUSA
  4. 4.Stanley Center for Psychiatric ResearchBroad InstituteCambridgeUSA

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