Psychiatric diagnoses as contemporaneous risk factors for suicide attempts among adolescents and young adults: developmental changes.

The purpose of this prospective, naturalistic study was to examine the relationships between suicide attempts and contemporaneous psychiatric disorders, and developmental changes in these relationships from adolescence to young adulthood. The sample consisted of 180 adolescents, 12-19 years of age at hospitalization, repeatedly assessed for up to 13 years (n = 1,825 assessments). Semistructured psychiatric diagnostic instruments were administered at repeated assessments to assess psychiatric disorders and suicide attempts. After controlling for demographic variables and prehospitalization suicide attempts, most contemporaneous psychiatric disorders (major depressive disorder [MDD], dysthymic disorder, generalized anxiety disorder [GAD], panic disorder, attention-deficit/hyperactivity disorder [AD/HD], conduct disorder, and substance use disorder [SUD]) were related to increased risk of attempts. The relationship between suicide attempts and MDD, GAD, AD/HD, and SUD strengthened as participants got older. MDD, dysthymic disorder, GAD, and panic disorder were more commonly associated with repeat than 1st-time suicide attempts. In sum, most major psychiatric disorders are associated with increased risk for suicide attempts, but the strength of the relationships between these disorders and attempts changes over the course of development.

Predictors of suicide attempts: state and trait components.

The authors examined the state and trait components of 3 predictors of suicide attempts (depression, hopelessness, and anxiety), and their relationship to suicidal behavior. Self-report questionnaire and interview data from 180 adolescents enrolled in a prospective naturalistic study were analyzed. Between 23% and 30% of the variance in the predictors was attributable to subjects' trait levels of these variables; the trait, as well as the state, components of the predictor variables were interrelated; and trait levels of these variables were consistently related to suicide attempts. To reduce long-term risk of suicide attempts, clinicians should focus not only on reducing short-term distress but also on reducing individuals' more enduring patterns (trait levels) of negative affectivity.

Severity of emotional and behavioral problems among poor and typical readers.

The purpose of this study was to examine the severity of behavioral and emotional problems among adolescents with poor and typical single word reading ability (N = 188) recruited from public schools and followed for a median of 2.4 years. Youth and parents were repeatedly assessed to obtain information regarding the severity and course of symptoms (depression, anxiety, somatic complaints. aggression, delinquent behaviors, inattention), controlling for demographic variables and diagnosis or ADHD. After adjustment for demographic variables and ADHD, poor readers reported higher levels of depression, trait anxiety, and somatic complaints than typical readers, but there were no difference, in reported self-reported delinquent or aggressive behaviors. Parent reports indicated no difference, in depression, anxiety or aggression between the two groups but indicated more inattention, somatic complaints, and delinquent behaviors for the poor readers. School and health professionals should carefully assess youth with poor reading for behavioral and emotional symptoms and provide services when indicated.

Rates and predictors of rehospitalization among formerly hospitalized adolescents.

OBJECTIVE: The authors examined rates and predictors of rehospitalization among 180 adolescents followed up for up to 10.3 years after discharge from an inpatient psychiatric unit. METHODS: In this prospective, naturalistic study, demographic variables, including gender, race, and age, and psychiatric variables, including diagnoses, prehospitalization suicide attempts, and previous hospitalizations, were examined as potential predictors of rehospitalization. Information about rehospitalizations was repeatedly assessed and verified with treatment records. RESULTS: During the follow-up period, 79 adolescents (44 percent) had one or more rehospitalizations. By six months after discharge, 19 percent of the adolescents had been rehospitalized. The mean time to first rehospitalization was estimated to be 5.7 years. Univariate analyses revealed significant differences between adolescents who were rehospitalized and those who were not in terms of age, presence of an affective disorder, and presence of a comorbid psychiatric disorder. In the multivariate predictor model, age and the presence of an affective disorder were the only significant predictors of rehospitalization. CONCLUSIONS: Clinicians should examine risk of rehospitalization before discharge, especially for younger patients and those with depression. Future research must focus on methods of intervention for this high-risk group.

Rates and predictors of aftercare services among formerly hospitalized adolescents: a prospective naturalistic study.

OBJECTIVE: To examine rates and predictors of aftercare use, lengths of service use, and predictors of the duration of aftercare service use among 180 adolescents monitored for up to 8.1 years after discharge from an inpatient psychiatry unit. METHOD: Drawing upon the Anderson-Newman model of service use, severity of illness, enabling, and predisposing factors assessed during the hospitalization were examined as potential predictors of service use. Information about outpatient mental health specialty services after hospitalization was assessed repeatedly and verified with treatment records. RESULTS: Seventy-three percent of adolescents received aftercare within the first month after discharge, and 92% eventually received outpatient services. Fifty-seven percent of adolescents remained in treatment 6 months after initiation of services. Psychiatric comorbidity, prior service use, and presence of a biological parent or grandparent in the home were related to initial service use. Psychiatric comorbidity and history of repeated suicide attempts were related to longer duration, and older age and minority group status were related to shorter duration of aftercare service use. CONCLUSIONS: Most adolescents receive aftercare services, but there are certain groups that are relatively less likely to access or remain in services. Interventions to decrease the barriers to care in such groups may be beneficial.