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.

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.