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Irritability and Suicidality in Clinically Referred Youth: Clarifying the Link by Examining the Roles of Age and Hope

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Abstract

Research has found an association between irritability and suicidal thoughts and behaviors (STB) in children and adolescents, but the overall evidence has been mixed and the nature of this association remains unclear. In this study, we investigated whether the link between irritability and STB might be more pronounced among older youth and those with lower levels of hope. Participants were 142 children and adolescents (ages 6–18) referred for mental health services at a university outpatient clinic. At intake, clinicians administered self-report measures assessing irritability, STB, hope, and depression. Multiple regression models with robust maximum likelihood estimation were used to test irritability’s association with STB, as well as age and hope as moderators. Irritability, hope, and age all showed significant associations with STB. Further, hope and age moderated the associations between irritability and STB; specifically, the link between irritability and STB was evident only at older ages (among adolescents, not children) and only at lower levels of hope. These findings are consistent with the view that hope may be a protective factor, and adolescence a vulnerability factor, in the association between irritability and STB. Results may help explain previous mixed findings on this association while also underscoring the role of irritability as a risk factor. Further research is warranted to better understand irritability and hope as transdiagnostic mechanisms in STB from childhood through adulthood, and through other informants and methods.

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Notes

  1. Both models were re-estimated controlling depression, and results changed slightly (see Supplement, Tables S1 and S2). To summarize, depression was a significant predictor of STB (p < .001) in all models and steps. Including depression resulted in a sizable increase in variance accounted for in both Model 1 (from 15–17% without depression to 32–33% with depression) and Model 2 (from 18–23% without depression to 30–33% with depression). The depression-STB link tended to overshadow other terms in these models, attenuating the hope × irritability interaction term to nonsignificance (p = .162) while the age × irritability interaction term remained robust (p = .047). Nonetheless, the overall protective effect of hope and the vulnerability effect of adolescence remained apparent (see Figures S1 and S2).

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Acknowledgements

We wish to thank the youths and caregivers who participated in this research. We also gratefully acknowledge the clinic?s staff, faculty, and graduate students for contributing to data collection and management, with special thanks to Madelaine Abel, Rachel Doyle, and Paula Fite. Portions of this research have been presented previously at the Vermont Congress on Pediatric Irritability and Dysregulation (2020) and at the JCCAP Future Directions Forum (2021).

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  1. Department of Psychology, Harvard University, Cambridge, MA, USA

    Sakshi Khurana & Melissa A. Wei

  2. Department of Psychology, University of Miami, Coral Gables, FL, USA

    Sakshi Khurana, Ashley R. Karlovich & Spencer C. Evans

  3. College of Education, DePaul University, Chicago, IL, USA

    Sakshi Khurana

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Khurana, S., Wei, M.A., Karlovich, A.R. et al. Irritability and Suicidality in Clinically Referred Youth: Clarifying the Link by Examining the Roles of Age and Hope. J Psychopathol Behav Assess 45, 640–649 (2023). https://doi.org/10.1007/s10862-023-10049-5

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