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Cited by 632Suicide and Self-Harm StudiesTreatment of Major DepressionPersonality Disorders and Psychopathology

Suicide attempts and nonsuicidal self-injury in the treatment of resistant depression in adolescents: findings from the TORDIA study

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Asarnow, Joan Rosenbaum, Porta, Giovanna, Spirito, Anthony, Emslie, Graham, Clarke, Greg, Wagner, Karen Dineen, Vitiello, Benedetto, Keller, Martin +5 more·2011·Journal of the American Academy of Child & Adolescent Psychiatry
DOI 10.1016/j.jaac.2011.04.003PMC PMC3143365
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Abstract

Objective To evaluate the clinical and prognostic significance of suicide attempts (SAs) and nonsuicidal self-injury (NSSI) in adolescents with treatment-resistant depression.Method Depressed adolescents who did not improve with an adequate SSRI trial (N = 334) were randomized to a medication switch (SSRI or venlafaxine), with or without cognitive-behavioral therapy. NSSI and SAs were assessed at baseline and throughout the 24-week treatment period.Results Of the youths, 47.4% reported a history of self-injurious behavior at baseline: 23.9% NSSI alone, 14% NSSI+SAs, and 9.5% SAs alone. The 24-week incidence rates of SAs and NSSI were 7% and 11%, respectively; these rates were highest among youths with NSSI+SAs at baseline. NSSI history predicted both incident SAs (hazard ratio [HR]= 5.28, 95% confidence interval [CI] = 1.80-15.47, z = 3.04, p = .002) and incident NSSI (HR = 7.31, z = 4.19, 95% CI = 2.88-18.54, p < .001) through week 24, and was a stronger predictor of future attempts than a history of SAs (HR = 1.92, 95% CI = 0.81-4.52, z = 2.29, p = .13). In the most parsimonious model predicting time to incident SAs, baseline NSSI history and hopelessness were significant predictors, adjusting for treatment effects. Parallel analyses predicting time to incident NSSI through week 24 identified baseline NSSI history and physical and/or sexual abuse history as significant predictors.Conclusions NSSI is a common problem among youths with treatment-resistant depression and is a significant predictor of future SAs and NSSI, underscoring the critical need for strategies that target the prevention of both NSSI and suicidal behavior.Clinical trial registration information Treatment of SSRI-Resistant Depression in Adolescents (TORDIA). URL: http://www.clinicaltrials.gov. Unique Identifier: NCT00018902.

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  • Environmental factors such as low socioeconomic status, firearm availability, and strained parental relationships elevate suicide risk.

    “Several studies have explored the role of environmental factors, such as low socioeconomic status, firearm availability, and strained parental relationships in elevating suicide risk (5–7).”

    From Exploring the neurobiological markers of suicidal behaviors in pediatric population: a narrative review (2026) · cites this paper as [5]

    The Results (Baseline Presentation; page unavailable) report more family conflict among adolescents with histories of both nonsuicidal self-injury and suicide attempts, offering limited support for the parental-relationships example. The paper does not establish that family conflict elevates suicide risk, and the passages found do not address low socioeconomic status or firearm availability. Its findings concern suicide attempts in adolescents with treatment-resistant depression, not suicide risk generally. (LLM, conf=0.85)

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  • Non-suicidal self-harm is strongly associated with suicide attempt history and predicts future attempts in longitudinal studies.

    “However, investigation of predictors of attempts among people who engage in non-suicidal self-harm is also important, because this factor is strongly associated with suicide attempt history and predicts future attempts in longitudinal studies.15, 16, 17, 18, 19”

    From Predictors of future suicide attempt among adolescents with suicidal thoughts or non-suicidal self-harm: a population-based birth cohort study (2019) · cites this paper as [18]

  • Suicidal thoughts and non-suicidal self-harm are strongly associated with suicide attempts.

    “Suicidal thoughts and non-suicidal self-harm are strongly associated with suicide attempts.”

    From Predictors of future suicide attempt among adolescents with suicidal thoughts or non-suicidal self-harm: a population-based birth cohort study (2019) · cites this paper as [18]

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Authors
Asarnow, J. R., Porta, G., Spirito, A., Emslie, G., Clarke, G., Wagner, K. D., Vitiello, B., Keller, M., Birmaher, B., McCracken, J., Mayes, T., Berk, M., & Brent, D. A.
Affiliations
  • University of California, Los Angeles (US)
  • University of Pittsburgh (US)
  • Brown University (US)
  • The University of Texas Southwestern Medical Center (US)
  • The University of Texas Medical Branch at Galveston (US)
  • National Institutes of Health (US)
Corresponding author
Asarnow, Joan Rosenbaum
ORCID
Venue
Journal of the American Academy of Child & Adolescent Psychiatry
Publisher
Elsevier BV
Published
2011-08
Volume
50
Issue
8
Pages
772-781
ISSN
0890-8567 (ISSN-L)
DOI
10.1016/j.jaac.2011.04.003
PMC
PMC3143365
OpenAlex
W2018920598
Cited by
632
References
36
Citations by year
2026: 20 · 2025: 45 · 2024: 34 · 2023: 65 · 2022: 38 · 2021: 54 · 2020: 52 · 2019: 44 · 2018: 53 · 2017: 36 · 2016: 47 · 2015: 44 · 2014: 41 · 2013: 36 · 2012: 18
FWCI
34.09
Type
journal article
Language
en
Update notices
erratum (2020-03-01)
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
Funders
National Institute of Mental Health (MH61958, U01MH061856, MH-66371, U01MH061835, U01MH061869, MH-61869, U01MH062014, MH61856, R01MH082856, MH-61835, MH61864, U01MH061958, P30MH066371, U01MH061864, MH62014)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Keywords
suicide attempts, non-suicidal self-injury, treatment-resistant depression, adolescents, venlafaxine, cognitive behavioral therapy, hopelessness, abuse history, antidepressant switching, prognostic factors
MeSH terms
Venlafaxine Hydrochloride, Suicide Prevention, Adolescent, Antidepressive Agents, Child, Combined Modality Therapy, Cyclohexanols, Depressive Disorder, Female, Humans, Male, Self Mutilation, Cognitive Behavioral Therapy, Proportional Hazards Models, Selective Serotonin Reuptake Inhibitors, Drug Substitution

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