Developmental psychopathology in suicidal and nonsuicidal adolescent girls.

OBJECTIVE: This study presents two distinct profiles of female suicide attempters based on social-cognitive development and investigates the relationship of both developmental and suicide risk variables in these profiles. METHOD: The sample included 139 girls, aged 13-16, admitted to an inpatient psychiatric hospital. Patients were divided into four groups based on their suicidal status (attempter/nonsuicidal) and ego development (preconformist/conformist level). RESULTS: Results support two developmental types of female suicide attempters that differed significantly on symptomatology, diagnoses, and defensive style. Preconformist attempters, the "angry-defiant" suicidal type, present with both depression and aggression as well as externalizing defense mechanisms. Conformist attempters, the "self-blaming" suicidal type, present with depression, and use more internalizing defenses to cope with conflict. Comparing suicide attempters and nonsuicidal girls, depression was found to be a risk factor for suicide at all developmental levels. Defense mechanisms were only associated with suicide at the preconformist developmental level. CONCLUSIONS: Social-cognitive development has an important impact on the expression of suicidal behavior in adolescent girls.

Adolescent suicide and defensive style.

This empirical study investigated the relation between ego defense mechanisms, diagnoses, and suicidality among 200 adolescent psychiatric patients ages 12 to 16 years. Based on a structured diagnostic interview, adolescents were divided into three groups: suicide attempters, suicidal ideators, and nonsuicidal patients. Using the Defense Mechanisms Inventory (DMI), suicidal adolescents scored higher on the defense of turning-against-self and lower on reversal, as compared to nonsuicidal adolescents. Although suicide was significantly more common among adolescents with an affective disorder, turning-against-self remained significantly associated with suicide attempt even when diagnosis was controlled for. Results demonstrate the importance of defense mechanisms in understanding adolescent suicidal behavior.

Adolescent suicidality: a clinical-developmental approach.

This study investigates the relation of ego development, age, gender, and diagnosis to suicidality among 219 adolescent psychiatric inpatients. Using the Diagnostic Interview Schedule for Children, adolescents were classified as suicide attempters or as nonsuicidal and were categorized into three diagnostic groups: affective disorder, conduct disorder, or mixed conduct-affective disorder. Ego development measurement was used to assess developmental maturity. Chi-square analyses demonstrated a relation between suicide attempts and developmental complexity. Attempters were more likely to be diagnosed with affective or mixed conduct-affective disorders and to be girls. Suicidality was not associated with age in this sample. Log-linear analyses demonstrated the interplay of known suicide risk factors with the important new dimension of developmental level.

Suicidality and psychopathology in hospitalized children and adolescents.

The present study presents the incidence of suicidality in a group of hospitalized children and adolescents and the relationship between suicidality, forms of psychopathology, and a variety of demographic and family variables. Specific attention is paid to age and gender differences. More than two-thirds of the sample (70%) showed evidence of suicide attempts, threats or ideation. One third attempted suicide at least once prior to or during their admission, and twice as many girls attempted suicide as boys. The majority of suicide attempters were 12 years or older at the time of their first attempt. Drug overdose was the method most frequently used. The suicide attempters and patients without a history of attempts did not differ on demographic and family psychopathology variables. Interestingly, no diagnostic differences were found between suicide attempters and non-suicidal patients. The majority of suicide attempters were diagnosed conduct disorder. Only a third of the attempters were diagnosed as suffering from an affective disorder. We therefore conclude that factors such as impulsivity and anger may contribute significantly to suicidal behavior in children and adolescents.