Prediction of Suicidal Behavior Risk among Adolescents Seen in Psychiatric Settings.

Abstract

Identifying adolescents at elevated risk for suicidal behavior, with the goal of preventing suicidal deaths and the morbidity associated with suicide attempts, is a national priority. However, there are important gaps in the literature concerning which adolescents are most vulnerable to suicidal behavior and how to best identify them. The overarching goal of this dissertation is to improve suicide risk prediction among high-risk adolescents who are most vulnerable to suicidal behavior and repeated suicidal crises and for whom accurate identification of risk is especially critical: psychiatrically hospitalized suicidal adolescents and youth seeking psychiatric emergency services. This dissertation project incorporated three studies examining: (1) the predictive validity and utility of an assessment approach incorporating youths' own assessment of their suicide risk in combination with a clinician-administrated instrument for youth evaluated in a psychiatric emergency department; (2) the impact of post-hospitalization course of suicidal ideation on subsequent suicidal crises, including suicide attempts and psychiatric rehospitalizations, and to identify the baseline predictors of a higher risk course after hospitalization; and (3) a promising theory of suicidal behavior, the Interpersonal-Psychological Theory of Suicidal Behavior, which hypothesizes a proximal pathway to suicidal behavior based on three constructs (low belonging, high perceived burdensomeness, acquired capability for suicide), to determine how well it predicts post-hospitalization suicide attempts within a sample of adolescents who were psychiatrically hospitalized for suicide risk. The results of these studies point to key indicators of risk associated with future suicide attempts and suicide-related crises: low confidence in ability to keep oneself from attempting suicide, persisting suicidal ideation, sense of being a burden on others (for adolescent males and when accompanied by acquired capability for suicide), and sense of thwarted belongingness (particularly for adolescent females and when combined with low acquired capability). The results also point to notable heterogeneity among these youths, synergistic effects of risk factors, and time-varying effects of predictors on suicidal behavior and suicide-risk related crises.