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Predicting Future Suicide Attempts Among Adolescent and Emerging Adult Psychiatric Emergency Patients
Open accessAbstract
The purpose of this study was to longitudinally examine specific characteristics of suicidal ideation in combination with histories of suicide attempts and non-suicidal self-injury (NSSI) to best evaluate risk for a future attempt among high-risk adolescents and emerging adults. Participants in this retrospective medical record review study were 473 (53% female; 69% Caucasian) consecutive patients, ages 15 to 24 years (M=19.4 years) who presented for psychiatric emergency services during a 9-month period. These patients' medical records, including a clinician-administered Columbia-Suicide Severity Rating Scale, were coded at the index visit and at future visits occurring within the next 18 months. Logistic regression models were used to predict suicide attempts during this period. Socioeconomic status, suicidal ideation severity (i.e., intent, method), suicidal ideation intensity (i.e., frequency, controllability), a lifetime history of suicide attempt, and a lifetime history of NSSI were significant independent predictors of a future suicide attempt. Suicidal ideation added incremental validity to the prediction of future suicide attempts above and beyond the influence of a past suicide attempt, whereas a lifetime history of NSSI did not. Sex moderated the relationship between the duration of suicidal thoughts and future attempts (predictive for male patients but not female). Results suggest value in incorporating both past behaviors and current thoughts into suicide risk formulation. Furthermore, suicidal ideation duration warrants additional examination as a potential critical factor for screening assessments evaluating suicide risk among high-risk samples, particularly for male patients.
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“The C-SSRS predicted suicide attempts with an OR of 4.8 (95% CI 2.23–10.32, p<.001) in adolescents and young adults following an emergency psychiatric evaluation.(41)”
From Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review (2021) · cites this paper as [41]
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Cites
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“This would align with the interpersonal theory of suicide (Joiner, 2005; Van Orden et al., 2010), as a past suicide attempt may represent a higher level of acquired capability—conceptualized as fearlessness about physical pain and death itself acquired through risky behaviors or painful and provocative experiences tha…”
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Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research
Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M., Huang, X., Musacchio, K. M., Jaroszewski, A. C., Chang, B. P., & Nock, M. K. (2017) · Psychological Bulletin · doi:10.1037/bul0000084 · Cited by 3,784
Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review
Mann, J. J., Michel, C. A., & Auerbach, R. P. (2021) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2020.20060864 · Cited by 655
Suicide Ideation and Attempts in a Pediatric Emergency Department Before and During COVID-19
Hill, R. M., Rufino, K. A., Kurian, S. R., Saxena, J. E., Saxena, K., & Williams, L. L. (2020) · PEDIATRICS · doi:10.1542/peds.2020-029280 · Cited by 391
Routinized Assessment of Suicide Risk in Clinical Practice: An Empirically Informed Update
Chu, C., Klein, K. M., Buchman‐Schmitt, J. M., Hom, M. A., Hagan, C. R., & Joiner, T. E. (2015) · Journal of Clinical Psychology · doi:10.1002/jclp.22210 · Cited by 284
The Zero Suicide Model: Applying Evidence-Based Suicide Prevention Practices to Clinical Care
Brodsky, B. S., Spruch-Feiner, A., & Stanley, B. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00033 · Cited by 221
Metadata
- Authors
- Horwitz, A. G., Czyz, E. K., & King, C. A.
- Affiliations
- University of Michigan (US)
- Corresponding author
- King, Cheryl A.
- Venue
- Journal of Clinical Child & Adolescent Psychology
- Publisher
- Informa UK Limited
- Published
- 2014-05-28
- Volume
- 44
- Issue
- 5
- Pages
- 751-761
- ISSN
- 1537-4416 (ISSN-L)
- 1537-4424
- PMC
- PMC4247360
- OpenAlex
- W2047011601
- Cited by
- 207
- References
- 42
- Citations by year
- 2026: 10 · 2025: 16 · 2024: 17 · 2023: 18 · 2022: 16 · 2021: 21 · 2020: 21 · 2019: 24 · 2018: 25 · 2017: 14 · 2016: 15 · 2015: 7 · 2014: 3
- FWCI
- 15.34
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Child & Adolescent Psychology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- This study was supported by a NIMH K24 award to Dr. Cheryl King. We gratefully acknowledge the physicians, nurses, social workers, and administrative staff in Psychiatric Emergency Services at the University of Michigan. We especially thank Dr. Rachel Glick, M.D., and John Kettley, ACSW, for their support and commitment to the integration of science and practice. We also thank Dr. Sandra Graham-Bermann for reviewing a previous draft of this manuscript.
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Social Sciences › Psychology › Social Psychology › Mental Health via Writing
- Keywords
- suicide attempts, suicidal ideation, non-suicidal self-injury, suicide risk prediction, adolescents, emerging adults, psychiatric emergency care, sex differences, Columbia Suicide Severity Rating Scale, suicide risk screening
- MeSH terms
- Adolescent, Emergency Services, Psychiatric, Female, Forecasting, Humans, Longitudinal Studies, Male, Medical Records, Predictive Value of Tests, Psychiatric Status Rating Scales, Retrospective Studies, Suicide, Suicide, Attempted, Reproducibility of Results, Logistic Models, Self-Injurious Behavior, Young Adult, Suicidal Ideation
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