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Cited by 165Suicide and Self-Harm StudiesPsychiatric care and mental health servicesPersonality Disorders and Psychopathology

Longitudinal trajectories of suicidal ideation and subsequent suicide attempts among adolescent inpatients.

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Czyz, Ewa K., King, Cheryl A.·2015·Journal of Clinical Child & Adolescent Psychology
DOI 10.1080/15374416.2013.836454PMC PMC3969893
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Abstract

A period of particularly high risk for suicide attempts among adolescent inpatients is within 12 months after discharge. However, little is known about longitudinal trajectories of suicidal ideation in this high-risk group and how these relate to posthospitalization suicide attempts and rehospitalizations. Our objectives were to identify these trajectories and examine their relationships with posthospitalization psychiatric crises. We also examined predictors of trajectory group membership. Participants (N = 376; ages 13-17; 72% female) were assessed at hospitalization and 3, 6, and 12 months later. Trajectory groups, and their predictors, were identified with latent class growth modeling. We used logistic regression to examine associations between trajectory groups and likelihood of suicide attempts and rehospitalization, controlling for attempt history. Three trajectory groups were identified: (a) subclinical ideators (31.6%), (b) elevated ideators with rapidly declining ideation (57.4%), and (c) chronically elevated ideators (10.9%). Adolescents in the chronically elevated ideation group had 2.29, confidence interval (CI) [1.08, 4.85], p = .03, and 4.15, CI [1.65, 10.44], p < .01, greater odds of attempting suicide and 3.23, CI [1.37, 7.69], p = .01, and 11.20, CI [4.33, 29.01], p < .001, greater odds of rehospitalization relative to rapidly declining and subclinical groups, respectively. Higher baseline hopelessness was associated with persisting suicidal ideation. Results suggest that suicidal ideation severity at hospitalization may not be an adequate marker for subsequent suicidal crises. It is important to identify adolescents vulnerable to persisting suicidal ideation, as they are at highest risk of psychiatric crises. Addressing hopelessness may facilitate faster declines in ideation after hospitalization. Results also highlight a need for consistent monitoring of these adolescents' suicidal ideation after discharge.

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  • Persistent death wishes in adolescents are typically interpreted as persistent or chronic suicidality.

    “Persistent death wishes in adolescents are typically interpreted as persistent or chronic suicidality, which is associated with increased hopelessness,8 emotion regulation problems,9 early-onset self-harm,10 and co-occurring psychiatric diagnoses.11”

    From Requests for Medical Assistance in Dying by Young Dutch People With Psychiatric Disorders (2025) · cites this paper as [8]

    The Discussion identifies a group of adolescent inpatients with persistent or chronic suicidal ideation, and the Results associate that trajectory with higher baseline hopelessness. The paper does not establish that persistent death wishes are typically interpreted as chronic suicidality; it studies suicidal ideation rather than that interpretation of death wishes. Page numbers are unavailable in our copy. (LLM, conf=0.83)

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  • The finding that improvement was most rapid after psychiatric hospitalization is consistent with earlier studies reporting depressive symptoms and suicide ideation reduction following the first week of admission or even brief intervention.

    “their improvement was most rapid after psychiatric hospitalization, consistent with earlier studies that reported depressive symptoms and suicide ideation reduction following the first week of admission or even brief intervention”

    From Time in treatment: Examining mental illness trajectories across inpatient psychiatric treatment (2020) · cites this paper as Czyz and King, 2015

    The Discussion and Implications sections report that suicidal ideation declined most sharply within three months after hospitalization and describe this as consistent with earlier inpatient studies. They do not report a reduction after the first week of admission or after a brief intervention, nor do they report a reduction in depressive symptoms. Page numbers are unavailable in our copy. (LLM, conf=0.88)

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  • Previous suicide attempts are the most robust clinical predictor of a future suicide attempt.

    “which includes previous suicide attempts, the most robust clinical predictor of a future suicide attempt.14,19”

    From Evidence-based youth suicide prevention and intervention in pediatric primary care settings. (2024) · cites this paper as [19]

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Research works printed but not linked: 4

  1. Centers for Disease Control and Prevention 2012a Youth Risk Behavior Survailance— United States, 2011 Morbidity and Mortality Weekly Report 61 No. 4 22673000
  2. Joiner T 2005 Why people die by suicide Cambridge, MA Harvard University Press
  3. King CA Jiang Q Czyz EK Kerr DCR under review One-year predictive validityof suicidal ideation for suicide attempts among adolescent psychiatric inpatients
  4. Reynolds WM 1992 Measurement of suicidal ideation in adolescents Paper presented at the American Association of Suicidology Annual Conference Chicago, IL

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Authors
Czyz, E. K., & King, C. A.
Affiliations
University of Michigan (US)
Corresponding author
King, Cheryl A.
ORCID
Venue
Journal of Clinical Child & Adolescent Psychology
Publisher
Informa UK Limited
Published
2013-09-30
Volume
44
Issue
1
Pages
181-193
ISSN
  • 1537-4416 (ISSN-L)
  • 1537-4424
DOI
10.1080/15374416.2013.836454
PMC
PMC3969893
OpenAlex
W1999044853
Cited by
165
References
43
Citations by year
2026: 15 · 2025: 18 · 2024: 13 · 2023: 13 · 2022: 18 · 2021: 14 · 2020: 18 · 2019: 18 · 2018: 15 · 2017: 5 · 2016: 14 · 2015: 1 · 2014: 3
FWCI
6.67
Type
journal article
Language
en
Open access
Locations
  • Journal of Clinical Child & Adolescent Psychology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (K24MH077705, R01 MH63881, K24MH77705, R01MH063881)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
Keywords
suicidal ideation, suicide attempts, adolescents, inpatient psychiatric hospitalization, longitudinal trajectories, hopelessness, suicide risk monitoring
MeSH terms
Adolescent, Female, Hospitalization, Humans, Inpatients, Longitudinal Studies, Male, Patient Discharge, Suicide, Attempted, Time Factors, Risk Assessment, Suicidal Ideation

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