Abstract
Objective: To evaluate the clinical and prognostic significance of suicide attempts (SAs) and nonsuicidal self-injury (NSSI) in adolescents with treatment-resistant depression. Method: Depressed adolescents who did not improve with an adequate SSRI trial (N = 334) were randomized to a medication switch (SSRI or venlafaxine), with or without cognitive-behavioral therapy. NSSI and SAs were assessed at baseline and throughout the 24-week treatment period. Results: Of the youths, 47.4% reported a history of self-injurious behavior at baseline: 23.9% NSSI alone, 14% NSSI+SAs, and 9.5% SAs alone. The 24-week incidence rates of SAs and NSSI were 7% and 11%, respectively; these rates were highest among youths with NSSI+SAs at baseline. NSSI history predicted both incident SAs (hazard ratio [HR]= 5.28, 95% confidence interval [CI] = 1.8015.47, z = 3.04, p =.002) and incident NSSI (HR = 7.31, z = 4.19, 95% CI = 2.8818.54, p <.001) through week 24, and was a stronger predictor of future attempts than a history of SAs (HR = 1.92, 95% CI = 0.814.52, z = 2.29, p =.13). In the most parsimonious model predicting time to incident SAs, baseline NSSI history and hopelessness were significant predictors, adjusting for treatment effects. Parallel analyses predicting time to incident NSSI through week 24 identified baseline NSSI history and physical and/or sexual abuse history as significant predictors. Conclusions: NSSI is a common problem among youths with treatment-resistant depression and is a significant predictor of future SAs and NSSI, underscoring the critical need for strategies that target the prevention of both NSSI and suicidal behavior.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 772-781 |
| Number of pages | 10 |
| Journal | Journal of the American Academy of Child and Adolescent Psychiatry |
| Volume | 50 |
| Issue number | 8 |
| DOIs | |
| State | Published - Aug 2011 |
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Keywords
- adolescents
- depression
- nonsuicidal self-injury
- self-injurious behavior
- suicide
ASJC Scopus subject areas
- Psychiatry and Mental health
- Developmental and Educational Psychology
Cite this
Suicide attempts and nonsuicidal self-injury in the treatment of resistant depression in adolescents : Findings from the TORDIA study. / Asarnow, Joan Rosenbaum; Porta, Giovanna; Spirito, Anthony; Emslie, Graham; Clarke, Greg; Wagner, Karen Dineen; Vitiello, Benedetto; Keller, Martin; Birmaher, Boris; McCracken, James; Mayes, Taryn; Berk, Michele; Brent, David A.
In: Journal of the American Academy of Child and Adolescent Psychiatry, Vol. 50, No. 8, 08.2011, p. 772-781.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Suicide attempts and nonsuicidal self-injury in the treatment of resistant depression in adolescents
T2 - Findings from the TORDIA study
AU - Asarnow, Joan Rosenbaum
AU - Porta, Giovanna
AU - Spirito, Anthony
AU - Emslie, Graham
AU - Clarke, Greg
AU - Wagner, Karen Dineen
AU - Vitiello, Benedetto
AU - Keller, Martin
AU - Birmaher, Boris
AU - McCracken, James
AU - Mayes, Taryn
AU - Berk, Michele
AU - Brent, David A.
PY - 2011/8
Y1 - 2011/8
N2 - Objective: To evaluate the clinical and prognostic significance of suicide attempts (SAs) and nonsuicidal self-injury (NSSI) in adolescents with treatment-resistant depression. Method: Depressed adolescents who did not improve with an adequate SSRI trial (N = 334) were randomized to a medication switch (SSRI or venlafaxine), with or without cognitive-behavioral therapy. NSSI and SAs were assessed at baseline and throughout the 24-week treatment period. Results: Of the youths, 47.4% reported a history of self-injurious behavior at baseline: 23.9% NSSI alone, 14% NSSI+SAs, and 9.5% SAs alone. The 24-week incidence rates of SAs and NSSI were 7% and 11%, respectively; these rates were highest among youths with NSSI+SAs at baseline. NSSI history predicted both incident SAs (hazard ratio [HR]= 5.28, 95% confidence interval [CI] = 1.8015.47, z = 3.04, p =.002) and incident NSSI (HR = 7.31, z = 4.19, 95% CI = 2.8818.54, p <.001) through week 24, and was a stronger predictor of future attempts than a history of SAs (HR = 1.92, 95% CI = 0.814.52, z = 2.29, p =.13). In the most parsimonious model predicting time to incident SAs, baseline NSSI history and hopelessness were significant predictors, adjusting for treatment effects. Parallel analyses predicting time to incident NSSI through week 24 identified baseline NSSI history and physical and/or sexual abuse history as significant predictors. Conclusions: NSSI is a common problem among youths with treatment-resistant depression and is a significant predictor of future SAs and NSSI, underscoring the critical need for strategies that target the prevention of both NSSI and suicidal behavior.
AB - Objective: To evaluate the clinical and prognostic significance of suicide attempts (SAs) and nonsuicidal self-injury (NSSI) in adolescents with treatment-resistant depression. Method: Depressed adolescents who did not improve with an adequate SSRI trial (N = 334) were randomized to a medication switch (SSRI or venlafaxine), with or without cognitive-behavioral therapy. NSSI and SAs were assessed at baseline and throughout the 24-week treatment period. Results: Of the youths, 47.4% reported a history of self-injurious behavior at baseline: 23.9% NSSI alone, 14% NSSI+SAs, and 9.5% SAs alone. The 24-week incidence rates of SAs and NSSI were 7% and 11%, respectively; these rates were highest among youths with NSSI+SAs at baseline. NSSI history predicted both incident SAs (hazard ratio [HR]= 5.28, 95% confidence interval [CI] = 1.8015.47, z = 3.04, p =.002) and incident NSSI (HR = 7.31, z = 4.19, 95% CI = 2.8818.54, p <.001) through week 24, and was a stronger predictor of future attempts than a history of SAs (HR = 1.92, 95% CI = 0.814.52, z = 2.29, p =.13). In the most parsimonious model predicting time to incident SAs, baseline NSSI history and hopelessness were significant predictors, adjusting for treatment effects. Parallel analyses predicting time to incident NSSI through week 24 identified baseline NSSI history and physical and/or sexual abuse history as significant predictors. Conclusions: NSSI is a common problem among youths with treatment-resistant depression and is a significant predictor of future SAs and NSSI, underscoring the critical need for strategies that target the prevention of both NSSI and suicidal behavior.
KW - adolescents
KW - depression
KW - nonsuicidal self-injury
KW - self-injurious behavior
KW - suicide
UR - http://www.scopus.com/inward/record.url?scp=79960750845&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79960750845&partnerID=8YFLogxK
U2 - 10.1016/j.jaac.2011.04.003
DO - 10.1016/j.jaac.2011.04.003
M3 - Article
C2 - 21784297
AN - SCOPUS:79960750845
VL - 50
SP - 772
EP - 781
JO - Journal of the American Academy of Child and Adolescent Psychiatry
JF - Journal of the American Academy of Child and Adolescent Psychiatry
SN - 0890-8567
IS - 8
ER -