Hostname: page-component-5d59c44645-7l5rh Total loading time: 0 Render date: 2024-02-29T20:19:15.366Z Has data issue: false hasContentIssue false

Prospective predictors of adolescent suicidality: 6-month post-hospitalization follow-up

Published online by Cambridge University Press:  30 August 2012

S. Yen*
Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
L. M. Weinstock
Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
M. S. Andover
Department of Psychology, Fordham University, Bronx, NY, USA
E. S. Sheets
Department of Psychology, Colby College, Waterville, ME, USA
E. A. Selby
Department of Psychology, Rutgers University, New Brunswick, NJ, USA
A. Spirito
Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
*Address for correspondence: S. Yen, Ph.D., 700 Butler Drive, Providence, RI 02906, USA. (Email:



The aim of this study was to examine prospective predictors of suicide events, defined as suicide attempts or emergency interventions to reduce suicide risk, in 119 adolescents admitted to an in-patient psychiatric unit for suicidal behaviors and followed naturalistically for 6 months.


Structured diagnostic interviews and self-report instruments were administered to adolescent participants and their parent(s) to assess demographic variables, history of suicidal behavior, psychiatric disorders, family environment and personality/temperament.


Baseline variables that significantly predicted time to a suicide event during follow-up were Black race, high suicidal ideation in the past month, post-traumatic stress disorder (PTSD), childhood sexual abuse (CSA), borderline personality disorder (BPD), low scores on positive affectivity, and high scores on aggression. In a multivariate Cox regression analysis, only Black race, CSA, positive affect intensity and high aggression scores remained significant.


Our findings suggest the following for adolescent populations: (1) in a very high-risk population, risk factors for future attempts may be more difficult to ascertain and some established risk factors (e.g. past suicide attempt) may not distinguish as well; and (2) cross-cutting constructs (e.g. affective and behavioral dysregulation) that underlie multiple psychiatric disorders may be stronger predictors of recurrent suicide events than psychiatric diagnoses. Our finding with respect to positive affect intensity is novel and may have practical implications for the assessment and treatment of adolescent suicide attempters.

Original Articles
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Aglan, A, Kerfoot, M, Pickles, A (2008). Pathways from adolescent deliberate self-poisoning to early adult outcomes: a six-year follow-up. Journal of Child Psychology and Psychiatry 49, 508515.CrossRefGoogle ScholarPubMed
Balis, T, Postolache, TT (2008). Ethnic differences in adolescent suicide in the United States. International Journal of Child Health and Human Development 1, 281296.Google ScholarPubMed
Boden, JM, Fergusson, DM, Horwood, LJ (2007). Anxiety disorders and suicidal behaviours in adolescence and young adulthood: findings from a longitudinal study. Psychological Medicine 37, 431440.CrossRefGoogle Scholar
Bondurant, H, Greenfield, B, Tse, SM (2004). Construct validity of the adolescent borderline personality disorder: a review. Canadian Child and Adolescent Psychiatry Review 13, 5357.Google ScholarPubMed
Borges, GJ, Angst, J, Nock, MK, Ruscio, AM, Kessler, RC (2008). Risk factors for the incidence and persistence of suicide-related outcomes: a 10-year follow-up study using the National Comorbidity Surveys. Journal of Affective Disorders 105, 2533.CrossRefGoogle ScholarPubMed
Brent, D, Greenhill, LL, Compton, S, Emslie, G, Wells, K, Walkup, JT, Vitiello, B, Bukstein, O, Stanley, B, Posner, K, Kennard, BD, Cwik, MF, Wagner, A, Coffey, B, March, JS, Riddle, M, Goldstein, T, Curry, J, Barnett, S, Capasso, L, Zelazney, J, Hughes, J, Shen, S, Gugga, SS, Tunder, JB (2009). The Treatment of Adolescent Suicide Attempters study (TASA): predictors of suicidal events in an open treatment trial. Journal of the American Academy of Child and Adolescent Psychiatry 48, 987996.CrossRefGoogle Scholar
Brent, DA, Johnson, BA, Perper, J, Connolly, J, Bridge, J, Bartle, S, Rather, C (1994). Personality disorder, personality traits, impulsive violence, and completed suicide in adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 33, 10801086.CrossRefGoogle ScholarPubMed
Brinkman-Sull, DC, Overholser, JC, Silverman, E (2000). Risk of future suicide attempts in adolescent psychiatric inpatients at 18-month follow-up. Suicide and Life-Threatening Behavior 30, 327340.CrossRefGoogle ScholarPubMed
Bronisch, T, Hofler, M, Lieb, R (2008). Smoking predicts suicidality: findings from a prospective community study. Journal of Affective Disorders 108, 135145.CrossRefGoogle ScholarPubMed
Buss, AH, Perry, M (1992). The aggression questionnaire. Journal of Personality and Social Psychology 63, 452459.CrossRefGoogle ScholarPubMed
Chronis-Tuscano, A, Molina, BS, Pelham, WE, Applegate, B, Dahlke, A, Overmyer, M, Lahey, BB (2010). Very early predictors of adolescent depression and suicide attempts in children with attention-deficit/hyperactivity disorder. Archives of General Psychiatry 67, 10441051.CrossRefGoogle ScholarPubMed
Epstein, NB, Baldwin, LM, Bishop, DS (1983). The McMaster Family Assessment Device. Journal of Marital and Family Therapy 9, 171180.CrossRefGoogle Scholar
Garlow, SJ, Purselle, D, Heninger, MD (2005). Ethnic differences in patterns of suicide across the life cycle. American Journal of Psychiatry 162, 319323.CrossRefGoogle ScholarPubMed
Goldston, DB, Daniel, SS, Erkanli, A, Reboussin, BA, Mayfield, A, Frazier, PH, Treadway, SL (2009). Psychiatric diagnoses as contemporaneous risk factors for suicide attempts among adolescents and young adults: developmental changes. Journal of Consulting and Clinical Psychology 77, 281290.CrossRefGoogle Scholar
Goldston, DB, Daniel, SS, Reboussin, DM, Frazier, PH, Kelley, AE (1999). Suicide attempts among formerly hospitalized adolescents: a prospective naturalistic study of risk during the first 5 years after discharge. Journal of the American Academy of Child and Adolescent Psychiatry 38, 660671.CrossRefGoogle ScholarPubMed
Goldston, DB, Reboussin, BA, Daniel, SS (2006). Predictors of suicide attempts: state and trait components. Journal of Abnormal Psychology 115, 842849.CrossRefGoogle ScholarPubMed
Gould, MS, King, R, Greenwald, MA, Fisher, P, Schwab-Stone, M, Kramer, R, Flisher, AJ, Goodman, S, Canino, G, Shaffer, D (1998). Psychopathology associated with suicidal ideation and attempts among children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 37, 915923.CrossRefGoogle ScholarPubMed
Greenfield, B, Henry, M, Weiss, M, Tse, SM, Guile, JM, Dougherty, JM, Dougherty, G, Zhang, X, Fombonne, E, Lis, E, Lapalme-Remis, S, Harnden, B (2008). Previously suicidal adolescents: predictors of six-month outcome. Journal of the Canadian Academy of Child and Adolescent Psychiatry 17, 197201.Google ScholarPubMed
Hills, AL, Afifi, TO, Cox, BJ, Bienvenu, OJ, Sareen, J (2009). Externalizing psychopathology and risk for suicide attempt: cross-sectional and longitudinal findings from the Baltimore Epidemiologic Catchment Area Study. Journal of Nervous and Mental Disease 197, 293297.CrossRefGoogle ScholarPubMed
Kaufman, J, Birmaher, B, Brent, D, Rao, U, Flynn, C, Moreci, P, Williamson, D, Ryan, N (1997). Schedule for Affective Disorders and Schizophrenia for School-Age Children – Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. Journal of the American Academy of Child and Adolescent Psychiatry 36, 980988.CrossRefGoogle ScholarPubMed
Keller, MB, Lavori, PW, Friedman, B, Nielsen, E, Endicott, J, McDonald-Scott, P, Andreasen, NC (1987). The Longitudinal Follow-up Evaluation. Archives of General Psychiatry 44, 540548.CrossRefGoogle Scholar
Kerr, DC, Washburn, JJ, Feingold, A, Kramer, AC, Ivey, AZ, King, CA (2007). Sequelae of aggression in acutely suicidal adolescents. Journal of Abnormal Child Psychology 35, 817830.CrossRefGoogle ScholarPubMed
Kessler, RC, Borges, G, Walters, EE (1999). Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Archives of General Psychiatry 56, 617626.CrossRefGoogle ScholarPubMed
King, CA, Kerr, DC, Passarelli, MN, Foster, CE, Merchant, CR (2010). One-year follow-up of suicidal adolescents: parental history of mental health problems and time to post-hospitalization attempt. Journal of Youth and Adolescence 39, 219232.CrossRefGoogle ScholarPubMed
King, CA, Segal, H, Kaminski, K, Naylor, MW, Ghaziuddin, N, Radpour, L (1995). A prospective study of adolescent suicidal behavior following hospitalization. Suicide and Life-Threatening Behavior 25, 327338.CrossRefGoogle ScholarPubMed
Kovacs, M, Goldston, D, Gatsonis, C (1993). Suicidal behaviors and childhood-onset depressive disorders: a longitudinal investigation. Journal of the American Academy of Child and Adolescent Psychiatry 32, 820.CrossRefGoogle ScholarPubMed
Larsen, RJ, Diener, E (1987). Affect intensity as an individual difference characteristic: a review. Journal of Research in Personality 21, 139.CrossRefGoogle Scholar
Larsen, RJ, Diener, E, Cropanzano, RS (1987). Cognitive operations associated with individual differences in affect intensity. Journal of Personality and Social Psychology 53, 767774.CrossRefGoogle ScholarPubMed
Lewinsohn, PM, Rohde, P, Seeley, JR (1994). Psychosocial risk factors for future adolescent suicide attempts. Journal of Consulting and Clinical Psychology 62, 297305.CrossRefGoogle ScholarPubMed
Lewinsohn, PM, Rohde, P, Seeley, JR (1996). Adolescent suicidal ideation and attempts: prevalence, risk factors, and clinical implications. Clinical Psychology: Science and Practice 3, 2546.Google Scholar
Lloyd-Richardson, EE, Perrine, N, Dierker, L, Kelley, ML (2007). Characteristics and functions of non-suicidal self-injury in a community sample of adolescents. Psychological Medicine 37, 11831192.CrossRefGoogle Scholar
Melhem, NM, Brent, DA, Ziegler, M, Iyengar, S, Kolko, D, Oquendo, M, Birmaher, B, Burke, A, Zelazny, J, Stanley, B, Mann, JJ (2007). Familial pathways to early-onset suicidal behavior: familial and individual antecedents of suicidal behavior. American Journal of Psychiatry 164, 13641370.CrossRefGoogle ScholarPubMed
Mitrou, F, Gaudie, J, Lawrence, D, Silburn, SR, Stanley, FJ, Zubrick, SR (2010). Antecedents of hospital admission for deliberate self-harm from a 14-year follow-up study using data-linkage. BMC Psychiatry 10, 111.CrossRefGoogle ScholarPubMed
Nock, MK, Hwang, I, Sampson, NA, Kessler, RC (2010). Mental disorders, comorbidity and suicidal behavior: results from the National Comorbidity Survey Replication. Molecular Psychiatry 15, 868876.CrossRefGoogle ScholarPubMed
Nrugham, L, Larsson, B, Sund, AM (2008). Predictors of suicidal acts across adolescence: influences of familial, peer and individual factors. Journal of Affective Disorders 109, 3545.CrossRefGoogle ScholarPubMed
O'Connor, RC, Fraser, L, Whyte, M, MacHale, S, Masterton, G (2008). A comparison of specific positive future expectancies and global hopelessness as predictors of suicidal ideation in a prospective study of repeat self-harmers. Journal of Affective Disorders 110, 207214.CrossRefGoogle Scholar
Parellada, M, Saiz, P, Moreno, D, Vidal, J, Llorente, C, Álvarez, M, García-Portilla, P, Ruiz-Sancho, A, Arango, C, Bobes, J (2008). Is attempted suicide different in adolescent and adults? Psychiatry Research 157, 131137.CrossRefGoogle ScholarPubMed
Perroud, N, Baud, P, Mouthon, D, Courtet, P, Malafosse, A (2011). Impulsivity, aggression and suicidal behavior in unipolar and bipolar disorders. Journal of Affective Disorders 134, 112118.CrossRefGoogle ScholarPubMed
Pfeffer, CR, Klerman, GL, Hurt, SW, Kakuma, T, Peskin, JR, Siefker, CA (1993). Suicidal children grow up: rates and psychosocial risk factors for suicide attempts during follow-up. Journal of the American Academy of Child and Adolescent Psychiatry 32, 106113.CrossRefGoogle ScholarPubMed
Prinstein, MJ, Nock, MK, Simon, V, Aikins, JW, Cheah, CS, Spirito, A (2008). Longitudinal trajectories and predictors of adolescent suicidal ideation and attempts following inpatient hospitalization. Journal of Consulting and Clinical Psychology 76, 92103.CrossRefGoogle ScholarPubMed
Reynolds, WM (1985). Suicide Ideation Questionnaire. Psychological Assessment Resources: Odessa, FL.Google Scholar
Riala, K, Alaraisanen, A, Taanila, A, Hakko, H, Timonen, M, Rasanen, P (2007). Regular daily smoking among 14-year-old adolescents increases the subsequent risk for suicide: the Northern Finland 1966 Birth Cohort Study. Journal of Clinical Psychiatry 68, 775780.CrossRefGoogle ScholarPubMed
Sanislow, CA, Pine, DP, Quinn, KJ, Kozak, MJ, Garvey, MA, Heinssen, RK, Wang, RK, Cuthbert, BN (2010). Developing constructs for psychopathology research: research domain criteria. Journal of Abnormal Psychology 119, 631639.CrossRefGoogle ScholarPubMed
Sharp, C, Ha, C, Michonski, J, Venta, A, Carbone, C (2012). Borderline personality disorder in adolescents: evidence in support of the Childhood Interview for DSM-IV Borderline Personality Disorder in a sample of adolescent inpatients. Comprehensive Psychiatry 53, 765774.CrossRefGoogle Scholar
Sorenson, SB, Golding, JM (1988). Suicide ideation and attempts in Hispanics and non-Hispanic whites: demographic and psychiatric disorder issues. Suicide and Life-Threatening Behavior 18, 205218.CrossRefGoogle ScholarPubMed
Spirito, A, Esposito-Smythers, C (2006). Attempted and completed suicide in adolescence. Annual Review of Clinical Psychology 2, 237266.CrossRefGoogle ScholarPubMed
Spirito, A, Valeri, S, Boergers, J, Donaldson, D (2003). Predictors of continued suicidal behavior in adolescents following a suicide attempt. Journal of Clinical Child and Adolescent Psychology 32, 284289.CrossRefGoogle ScholarPubMed
Wichstrom, L (2000). Predictors of adolescent suicide attempters: a naturally representative longitudinal study of Norwegian adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 39, 603610.CrossRefGoogle Scholar
Yen, S, Shea, MT, Sanislow, CA, Grilo, CM, Skodol, AE, Gunderson, JG, McGlashan, TH, Zanarini, MC, Morey, LC (2004). Borderline personality disorder criteria associated with prospectively observed suicidal behavior. American Journal of Psychiatry 161, 12961298.CrossRefGoogle ScholarPubMed
Yen, S, Shea, MT, Sanislow, CA, Skodol, AE, Grilo, CM, Stout, RL, Morey, LC, Zanarini, MC, McGlashan, TH, Daversa, MT, Gunderson, JG (2009). Personality traits as prospective predictors of suicide attempts. Acta Psychiatrica Scandinavica 120, 222229.CrossRefGoogle ScholarPubMed
Zahl, DL, Hawton, K (2004). Repetition of deliberate self-harm and subsequent suicide risk: long-term follow-up study of 11,583 patients. British Journal of Psychiatry 185, 7075.CrossRefGoogle Scholar
Zanarini, MC, Frankenburg, FR, Chauncey, DL, Gunderson, JG (1987). The diagnostic interview for personality disorders: interrater and test-retest reliability. Comprehensive Psychiatry 28, 467480.CrossRefGoogle ScholarPubMed
Zanarini, MC, Frankenburg, FR, Sickel, AE, Yong, L (1996). The Diagnostic Interview for DSM-IV Personality Disorder. Laboratory for the Study of Adult Development, McLean Hospital: Belmont, MA.Google Scholar