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Trajectories of Suicidal Ideation among Adolescents Following Psychiatric Hospitalization

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Abstract

Suicidal ideation (SI) is a common presenting problem for psychiatric hospitalizations in adolescents and often persists following discharge. This study examines whether distinct trajectories of SI could be delineated following hospitalization and the risk factors most strongly related to these trajectories. Adolescents (N = 104; 76 females; 28 males) were followed for 6 months after discharge from inpatient or partial hospitalization. Semi-parametric group modeling identified SI trajectory group membership. In all, 33.7% of adolescents fell in a Subclinical SI group, 43.3% in a Declining SI group, and 23.1% in a Chronic SI group. Multinomial logistic regression was utilized to examine baseline predictors of group membership. Emotion dysregulation differentiated Chronic SI from Declining SI. In multivariate analyses, adolescents endorsing greater non-acceptance of emotional responses (OR =1.18) and more limited access to emotion regulation strategies (OR =1.12) were more likely to belong to the Chronic SI than Declining SI trajectory. Those in the Chronic SI group also had the greatest number of suicide attempts and hospitalizations in the 6 months post-discharge. These results suggest that clinicians should closely monitor and address emotion dysregulation when assessing suicide risk. Greater dysregulation may require more intensive services in order to have an effect on chronic SI.

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Notes

  1. Analyses using the Subclinical SI group as the reference group are available upon request.

  2. When all predictors were included in the multivariate model, a potential suppressor effect was observed for the emotion regulation variables, likely due to the high correlation between non-acceptance of emotional responses and limited access to emotion regulation strategies (r = .60, p < .001). Therefore, we ran the multivariate model twice, once including non-acceptance of emotional responses and once including limited access to emotion regulation strategies. The suppressor effect remained in the latter model, so our final model only includes the non-acceptance of emotional responses subscale. For more details regarding suppressor effects, see Cohen and Cohen (1983), Tzelgov and Avishai (1991), Tabachnick and Fidell (1996).

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Authors and Affiliations

  1. Warren Alpert Medical School of Brown University, Providence, RI, USA

    Jennifer C. Wolff, Stephanie Davis, Richard T. Liu, Bridget A. Nestor, Elisabeth A. Frazier, Maya Massing Schaffer & Anthony Spirito

  2. Bradley Hospital, Riverside, RI, USA

    Jennifer C. Wolff, Stephanie Davis, Richard T. Liu, Shayna M. Cheek, Elisabeth A. Frazier & Anthony Spirito

  3. Rhode Island Hospital, Providence, RI, USA

    Jennifer C. Wolff

  4. Teachers College, Columbia University, New York, NY, USA

    Christine B. Cha

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  1. Jennifer C. Wolff
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  2. Stephanie Davis
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  3. Richard T. Liu
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Correspondence to Jennifer C. Wolff.

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Funding

This study was funded by the National Institute of Mental Health (1R01MH099703-01).

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The authors declare that they have no conflict of interest.

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

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

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Wolff, J.C., Davis, S., Liu, R.T. et al. Trajectories of Suicidal Ideation among Adolescents Following Psychiatric Hospitalization. J Abnorm Child Psychol 46, 355–363 (2018). https://doi.org/10.1007/s10802-017-0293-6

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  • DOI: https://doi.org/10.1007/s10802-017-0293-6

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