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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

Abstract

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.

Keywords

Children Outpatients Suicidal thoughts and behaviors Comorbidity Symptom dimensions 

Notes

Funding

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.

References

  1. 1.
    Centers for Disease Control and Prevention NCfIPaC (2015) Web-based injury statistics query and reporting system (WISQARS). http://www.cdc.gov/ncipc/wisqars
  2. 2.
    Lindqvist P, Johansson L, Karlsson U (2008) In the aftermath of teenage suicide: a qualitative study of the psychosocial consequences for the surviving family members. BMC Psychiatry 8:26CrossRefGoogle Scholar
  3. 3.
    Cerel J, Roberts TA, Nilsen WJ (2005) Peer suicidal behavior and adolescent risk behavior. J Nerv Ment Dis 193:237–243CrossRefGoogle Scholar
  4. 4.
    Shepard DS, Gurewich D, Lwin AK, Reed GA Jr, Silverman MM (2016) Suicide and suicidal attempts in the United States: costs and policy implications. Suicide Life Threat Behav 46:352–362CrossRefGoogle Scholar
  5. 5.
    Hogan MF, Grumet JG (2016) Suicide prevention: an emerging priority for health care. Health Aff (Millwood) 35:1084–1090CrossRefGoogle Scholar
  6. 6.
    Franklin JC, Ribeiro JD, Fox KR, Bentley KH, Kleiman EM, Huang X, Musacchio KM, Jaroszewski AC, Chang BP, Nock MK (2017) Risk factors for suicidal thoughts and behaviors: a meta-analysis of 50 years of research. Psychol Bull 143:187–232CrossRefGoogle Scholar
  7. 7.
    Foley DL, Goldston DB, Costello EJ, Angold A (2006) Proximal psychiatric risk factors for suicidality in youth: the Great Smoky Mountains Study. Arch Gen Psychiatry 63:1017–1024CrossRefGoogle Scholar
  8. 8.
    Goldston DB, Erkanli A, Daniel SS, Heilbron N, Weller BE, Doyle O (2016) Developmental trajectories of suicidal thoughts and behaviors from adolescence through adulthood. J Am Acad Child Adolesc Psychiatry 55:400–407CrossRefGoogle Scholar
  9. 9.
    Shaffer D, Gould MS, Fisher P, Trautman P, Moreau D, Kleinman M, Flory M (1996) Psychiatric diagnosis in child and adolescent suicide. Arch Gen Psychiatry 53:339–348CrossRefGoogle Scholar
  10. 10.
    Sheftall AH, Asti L, Horowitz LM, Felts A, Fontanella CA, Campo JV, Bridge JA (2016) Suicide in elementary school-aged children and early adolescents. Pediatrics 138:e20160436CrossRefGoogle Scholar
  11. 11.
    Faraone SV, Asherson P, Banaschewski T, Biederman J, Buitelaar JK, Ramos-Quiroga JA, Rohde LA, Sonuga-Barke EJ, Tannock R, Franke B (2015) Attention-deficit/hyperactivity disorder. Nat Rev Dis Primers 1:15020CrossRefGoogle Scholar
  12. 12.
    Pfeffer CR, Plutchik R, Mizruchi MS, Lipkins R (1986) Suicidal behavior in child psychiatric inpatients and outpatients and in nonpatients. Am J Psychiatry 143:733–738CrossRefGoogle Scholar
  13. 13.
    Dickerson Mayes S, Calhoun SL, Baweja R, Mahr F (2015) Suicide ideation and attempts in children with psychiatric disorders and typical development. Crisis 36:55–60CrossRefGoogle Scholar
  14. 14.
    Milling L, Gyure K, Davenport CW, Bair P (1991) Suicidal behavior among psychiatric outpatient children: an estimate of prevalence. Child Psychiatry Hum Dev 21:283–289CrossRefGoogle Scholar
  15. 15.
    Pfeffer CR, Conte HR, Plutchik R, Jerrett I (1980) Suicidal behavior in latency-age children. An outpatient population. J Am Acad Child Psychiatry 19:703–710CrossRefGoogle Scholar
  16. 16.
    Turecki G, Brent DA (2016) Suicide and suicidal behaviour. Lancet 387:1227–1239CrossRefGoogle Scholar
  17. 17.
    Fite PJ, Poquiz J, Frazer AL, Reiter N (2017) Further evaluation of associations between reactive and proactive aggression and suicidal behavior in a treatment seeking sample of youth. Child Psychiatry Hum Dev 48:903–910CrossRefGoogle Scholar
  18. 18.
    Arcelus J, Vostanis P (2005) Psychiatric comorbidity in children and adolescents. Curr Opin Psychiatry 18:429–434CrossRefGoogle Scholar
  19. 19.
    McConaughy SH, Achenbach TM (1994) Comorbidity of empirically based syndromes in matched general population and clinical samples. J Child Psychol Psychiatry 35:1141–1157CrossRefGoogle Scholar
  20. 20.
    Agosti V, Chen Y, Levin FR (2011) Does attention deficit hyperactivity disorder increase the risk of suicide attempts? J Affect Disord 133:595–599CrossRefGoogle Scholar
  21. 21.
    Balazs J, Miklosi M, Kereszteny A, Dallos G, Gadoros J (2014) Attention-deficit hyperactivity disorder and suicidality in a treatment naive sample of children and adolescents. J Affect Disord 152–154:282–287CrossRefGoogle Scholar
  22. 22.
    Glenn CR, Cha CB, Kleiman EM, Nock MK (2017) Understanding suicide risk within the Research Domain Criteria (RDoC) framework: insights, challenges, and future research considerations. Clin Psychol Sci 5:568–592CrossRefGoogle Scholar
  23. 23.
    Achenbach TM, Rescorla LA (2001) Manual for the ASEBA school-age forms & profiles. University of Vermont, Research Center for Children, Youth, & Families, BurlingtonGoogle Scholar
  24. 24.
    Gadow KD, Sprafkin JN (2002) Child Symptom Inventory-fourth edition: screening and norms manual. Checkmate Plus, Stony BrookGoogle Scholar
  25. 25.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical variables. Biometrics 33:159–174CrossRefGoogle Scholar
  26. 26.
    Pavuluri MN, Henry DB, Devineni B, Carbray JA, Birmaher B (2006) Child mania rating scale: development, reliability, and validity. J Am Acad Child Adolesc Psychiatry 45:550–560CrossRefGoogle Scholar
  27. 27.
    Constantino JN, Gruber CP (2005) Social Responsiveness Scale. Western Psychological Services, Los AngelesGoogle Scholar
  28. 28.
    Chatterjee S, Price B (1991) Regression analysis by example, 2nd edn. Wiley, New YorkGoogle Scholar
  29. 29.
    Mokkenstorm JK, Kerkhof A, Smit JH, Beekman ATF (2017) Is it rational to pursue zero suicides among patients in health care? Suicide Life Threat Behav.  https://doi.org/10.1111/sltb.12396 CrossRefPubMedGoogle Scholar
  30. 30.
    Gould MS, King R, Greenwald S, Fisher P, Schwab-Stone M, Kramer R, Flisher AJ, Goodman S, Canino G, Shaffer D (1998) Psychopathology associated with suicidal ideation and attempts among children and adolescents. J Am Acad Child Adolesc Psychiatry 37:915–923CrossRefGoogle Scholar
  31. 31.
    Rodriguez KA, Kendall PC (2014) Suicidal ideation in anxiety-disordered youth: identifying predictors of risk. J Clin Child Adolesc Psychol 43:51–62CrossRefGoogle Scholar
  32. 32.
    McCloskey MS, Ammerman BA (2018) Suicidal behavior and aggression-related disorders. Curr Opin Psychol 22:54–58CrossRefGoogle Scholar
  33. 33.
    Doyle AE, Faraone SV (2002) Familial links between attention deficit hyperactivity disorder, conduct disorder, and bipolar disorder. Curr Psychiatry Rep 4:146–152CrossRefGoogle Scholar
  34. 34.
    Brent DA, Mann JJ (2005) Family genetic studies, suicide, and suicidal behavior. Am J Med Genet C 133C:13–24CrossRefGoogle Scholar
  35. 35.
    Brent DA, Melhem NM, Oquendo M, Burke A, Birmaher B, Stanley B, Biernesser C, Keilp J, Kolko D, Ellis S, Porta G, Zelazny J, Iyengar S, Mann JJ (2015) Familial pathways to early-onset suicide attempt: a 5.6-year prospective study. JAMA Psychiatry 72:160–168CrossRefGoogle Scholar
  36. 36.
    Kelleher I, Lynch F, Harley M, Molloy C, Roddy S, Fitzpatrick C, Cannon M (2012) Psychotic symptoms in adolescence index risk for suicidal behavior: findings from 2 population-based case-control clinical interview studies. Arch Gen Psychiatry 69:1277–1283CrossRefGoogle Scholar
  37. 37.
    Stallman HM (2018) Coping planning: a patient-centred and strengths-focused approach to suicide prevention training. Australas Psychiatry 26:141–144CrossRefGoogle Scholar
  38. 38.
    Whalen DJ, Dixon-Gordon K, Belden AC, Barch D, Luby JL (2015) Correlates and consequences of suicidal cognitions and behaviors in children ages 3 to 7 years. J Am Acad Child Adolesc Psychiatry 54:926–937CrossRefGoogle Scholar
  39. 39.
    Ljung T, Chen Q, Lichtenstein P, Larsson H (2014) Common etiological factors of attention-deficit/hyperactivity disorder and suicidal behavior: a population-based study in Sweden. JAMA Psychiatry 71:958–964CrossRefGoogle Scholar
  40. 40.
    Hinshaw SP, Owens EB, Zalecki C, Huggins SP, Montenegro-Nevado AJ, Schrodek E, Swanson EN (2012) Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: continuing impairment includes elevated risk for suicide attempts and self-injury. J Consult Clin Psychol 80:1041–1051CrossRefGoogle Scholar

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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