Predicting Future Suicide Attempts Among Adolescent and Emerging Adult Psychiatric Emergency Patients

Adam G Horwitz, Ewa K Czyz, Cheryl A King
Journal of Clinical Child and Adolescent Psychology 2015, 44 (5): 751-61
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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