Adolescent psychiatric inpatients' risk of suicide attempt at 6-month follow-up.

Adolescent inpatients (of whom 48 were admitted for a suicide attempt, 33 were admitted for suicidal ideation, and 53 had no history of clinically significant suicidal ideation or attempt), were interviewed while in the hospital and then followed up 6 months later. Of the 134 patients followed up, 13 (9.7%) had made a suicide attempt. The vast majority of those who attempted suicide had been suicidal while in the hospital (12/13 or 92.3%). Other risk factors for suicidal behavior include major depression at intake, affective disorder with nonaffective comorbidity, a depressive disorder that continued through follow-up, death of a relative, and family financial problems. Suicidal inpatients, particularly those with chronic and recurrent affective illness, are at substantial risk for making a suicide attempt within 6 months of discharge. At follow-up, an even higher proportion showed attempts or suicidal ideation with a plan (N = 36 or 26.8%), with risk factors similar to those noted above. More intense outpatient or partial hospital interventions as a transition from the inpatient environment may be necessary to reduce the rate of recidivism among suicidal adolescents.

Adolescent witnesses to a peer suicide.

OBJECTIVE: This case-control study attempts to evaluate the psychological impact of witnessing a suicide on high school students. METHOD: Twenty-eight high school students witnessed a firearms suicide and the serious injury of another student while riding a school bus. They were assessed 2 months after the event, and their responses were compared with 28 demographically similar adolescents from another community who had not been exposed to suicide. RESULTS: The exposed students, when compared with the controls, had higher rates of new-onset anxiety disorder and a trend for increased rates of new-onset post-traumatic stress disorder (PTSD). Within the exposed group, measures of the closeness of the relationship to both the suicide victim and the student who was injured were correlated with the severity of PTSD symptomatology. Within the exposed group, other factors that predisposed to new-onset disorder included family history of affective illness, family history of suicide attempt, and stressful life events occurring in the year before exposure. CONCLUSIONS: In combination with the extant literature, this study demonstrates that adolescents who witness a traumatic suicidal death are at risk for the development of psychopathology, specifically, anxiety disorders and PTSD.

Progressive relaxation, EMG biofeedback and biofeedback placebo in the treatment of sleep-onset insomnia.

This paper describes a study in which progressive relaxation, EMG frontalis biofeedback, and a biofeedback placebo manipulation were compared in the treatment of severe insomnia with 40 chronically sleep-disturbed adult patients. Progressive relaxation and EMG biofeedback led to significant reductions in both reported sleep-onset latency and depressive symptomatology. However, when compared individually with the biofeedback placebo group, neither progressive relaxation nor EMG biofeedback emerged as significantly more effective on the sleep-onset latency measure. The clinical improvement in the biofeedback placebo group suggests that expectancies related to the ability to relax may contribute to the therapeutic effectiveness of relaxation strategies, even with chronic, severely disturbed insomniacs. Improvement in sleep-onset latency was not significantly related to reductions in frontalis EMG activity either within or between groups, a finding which raises questions concerning the clinical role and importance of physiological relaxation in the treatment of sleep-onset disturbance.