PORTLAND, ORE. – Depressed teenagers are more likely to attempt suicide without a triggering event, and teenagers who make an attempt after an event are more likely to have poorer problem-solving skills but to be less depressed, a study has shown.
The findings suggest that when events trigger suicide attempts or ideations, adolescents might benefit most from help with problem-solving skills. In the absence of an event, teenagers might benefit more from depression treatment, according to lead author Ryan Hill, a clinical psychology graduate student at Florida International University in Miami.
"For those who didn’t have precipitating events, it may be that we need to intervene more at the level of stopping their depression. In those with preceding events, maybe we need to identify more beforehand those who have poorer problem solving and teach them some problem-solving skills," Mr. Hill said at the annual conference of the American Association of Suicidology.
Also, suicide risk should be routinely monitored among adolescents with severe depression or a past attempt, given that suicidal crises may occur in the absence of an identifiable trigger. Among youth with low levels of depression, suicide risk should be monitored closely during the days following a stressful life event, he said.
Mr. Hill and his associates interviewed 130 ethnically diverse adolescents aged 13-17, most of whom were female. The teens were hospitalized for suicide attempts or severe ideation. The investigators wanted to determine whether triggering events occurred within a week of the teenagers’ hospitalizations, and also assess their levels of depression, problem-solving skills, and impulsivity.
Consistent with rates from previous studies, 63% (82) of the teens said an event triggered their crises; it occurred within an average of 3.2 days before hospitalization.
The most common were interpersonal events – arguments with family or friends, breakups, or deaths in the family. Getting in trouble with the police or other legal problems were the second most common events. The mean impact of the events, as assessed by researchers, was 3.2, with 5 representing the most severe impact.
There were no demographic differences between teenagers who had a trigger and the 48 who did not. Impulsivity scores were similar in the two groups.
However, "those who did not have an event before their crises seemed to show more of what we would traditionally think of as the [suicide] risk factors. They had more severe depression; they were more likely to have made a past attempt; and they had greater suicidal intent if they had made an attempt. But they had better problem-solving skills," Mr. Hill said.
"Those who had an event occur before their suicidal crises had poorer problem-solving skills, but seemed to have lower levels of those other risk factors. [They had] some combination of a stressful event and poor problem solving," he said.
For example, the event group had mean problem-solving scores of 123.6. The no-event group had mean scores of 113.3, with higher scores indicating worse skills.
The event-group’s mean score on the Beck Depression Inventory was 22.4, but 28.4 in the no-event group, with a higher score indicating worse symptoms; 15% of the event group had made previous suicide attempts, compared with 29% in the no-event group.
The findings were statistically significant and indicate that "we need to consider the different ways adolescents may end up at a suicidal crisis. Only when we start to do that more broadly will we get at the best prevention programs and the best ways to reach these adolescents," Mr. Hill said.
He said he had no relevant financial disclosures.