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.
N1 - Funding Information:
Funded by National Institute of Mental Health grants MH61835 (Pittsburgh); MH61856 (Galveston); MH61864 (UCLA); MH61869 (Portland); MH61958 (Dallas); and MH62014 (Brown), and the Advanced Center for Early-Onset Mood and Anxiety Disorders ( MH66371 , D.A.B.).
Funding Information:
Disclosure: Dr. Asarnow has received research grants from the National Institute of Mental Health . She has received honoraria from the California Institute of Mental Health, Hathaways-Sycamores, and the Melissa Institute. Dr. Emslie receives research support from the National Institute of Mental Health, Biobehavioral Diagnostics Inc., Eli Lilly and Co., Forest, GlaxoSmithKline, and Somerset. He has served as a consultant for Biobehavioral Diagnostics Inc., Eli Lilly and Co., Forest, GlaxoSmithKline, Pfizer, and Wyeth. He has served on the speakers' bureau for Forest. Dr. Wagner has received honoraria from Physicians Postgraduate Press, the National Institutes of Health, CMP Medica, UBM Medica, Krog and Partners, American Institute of Biological Sciences, Mexican Psychiatric Association, American Academy of Child and Adolescent Psychiatry, American Psychiatric Association, Madison Institute of Medicine, Wolters Kluwer Health, Contemporary Forums, Quantia Communications, Doctors Hospital at Renaissance, CME LLC, Springer Publishing. He serves as a deputy editor of the Journal of Clinical Psychiatry. Dr. Keller has served as a consultant to Medtronic, Sierra Neuropharmaceuticals, and CENEREX (without renumeration). He has received grant support from Pfizer . Dr. Birmaher has served as a consultant for Schering Plough. He has received research support from the National Institute of Mental Health. He has participated in forums sponsored by Dey Pharma, L.P.: Major Depressive Disorder Regional Advisory Board Meeting. He has received royalties for publications from Random House, and Lippincott Williams and Wilkins. Dr. McCracken has received research support from Eli Lilly and Co., McNeil, Bristol-Myers Squibb, and Shire; and has served as a consultant for Shire, Eli Lilly and Co., McNeil, Pfizer, Janssen, Johnson and Johnson, Novartis, and Wyeth. Dr. Brent has received research support from the National Institutes of Mental Health. He has received royalties from Guilford Press. He serves as an editor of UpToDate Psychiatry. Drs. Spirito, Berk, Clarke, and Vitiello, and Ms. Mayes and Ms. Porta, report no biomedical financial interests or potential conflicts of interest.
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
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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 Psychiatry
JF - Journal of the American Academy of Child Psychiatry
SN - 0890-8567
IS - 8
ER -