Predicting Suicide Crises among Adolescents at High Risk

The authors of a study of adolescents released from inpatient psychiatric units after a suicidal crisis report that some established risk factors for suicidal behavior (such as a past suicide attempt) may not be as useful for predicting future suicide risk for high-risk adolescents, given the high prevalence of these risk factors in this population. Their findings suggest that better predictors of risk for young people at extremely elevated risk for suicidal behaviors include a history of child sexual abuse, high levels of aggression, and low positive affect intensity (that is, a more muted expression of positive feelings, such as enjoyment, interest, and excitement). These three characteristics were found to predict future suicide attempts or crises within 6 months of discharge from a psychiatric unit. The mean time for participants experiencing a suicide event after discharge was 8 weeks.

The authors report that their research had two unanticipated results. One was that a history of a previous suicide attempt was not a significant predictor of suicide events (that is, suicide attempts or “any emergency intervention taken to prevent a suicidal behavior”). They suggest that a history of previous attempts may be a better predictor of future risk in lower-risk populations than in high-risk populations, which include a much larger proportion of adolescents with a history of attempts. A second unanticipated result was that the only demographic predictor of future attempts was black race. However, the small number of African American participants in the study limits the generalization of this result. The study confirmed that adolescents released from psychiatric hospitalization after a suicidal crisis were at extremely high risk for another suicide attempt or crisis. In the 6 months after release, 18 percent of these young people made a suicide attempt, 23 percent were admitted to an emergency department for a suicide-related problem, and 36 percent experienced a suicide event.

SPRC Commentary

This research underscores two important issues. The first is the importance of understanding how to accurately assess suicide risk for populations in which the prevalence of the usual indicators is so great that they cannot be effectively used to predict who may be at highest risk for suicide. This research also reminds us of the importance of continuity of care and follow-up for people discharged from hospitalization after a suicidal crisis. This follow-up needs to include open and efficient communication between inpatient and outpatient treatment providers; continued treatment and periodic reevaluation; and educating families and others in support networks on recognizing and responding to the warning signs of acute risk for suicidal behaviors.

Yen, S., Weinstock, L. M., Andover, M. S., Sheets, E. S., Selby, E. A., & Spirito, A. (2012). Prospective predictors of adolescent suicidality: 6-month post-hospitalization follow-up. Psychological Medicine. Advance online publication. doi:10.1017/S0033291712001912