Arielle H. Sheftall

Impaired Decision Making in Adolescent Suicide Attempters

OBJECTIVE Decision-making deficits have been linked to suicidal behavior in adults. However, it remains unclear whether impaired decision making plays a role in the etiopathogenesis of youth suicidal behavior. The purpose of this study was to examine decision-making processes in adolescent suicide attempters and never-suicidal comparison subjects. METHOD Using the Iowa Gambling Task, the authors examined decision making in 40 adolescent suicide attempters, 13 to 18 years old, and 40 never-suicidal, demographically matched psychiatric comparison subjects. RESULTS Overall, suicide attempters performed significantly worse on the Iowa Gambling Task than comparison subjects. This difference in overall task performance between the groups persisted in an exact conditional logistic regression analysis that controlled for affective disorder, current psychotropic medication use, impulsivity, and hostility (adjusted odds ratio = 0.96, 95% confidence interval = 0.90-0.99, p < 0.05). A two-way repeated-measures analysis of variance revealed a significant group-by-block interaction, demonstrating that attempters failed to learn during the task, picking approximately the same proportion of disadvantageous cards in the first and final blocks of the task. In contrast, comparison subjects picked proportionately fewer cards from the disadvantageous decks as the task progressed. Within the attempter group, overall task performance did not correlate with any characteristic of the index attempt or with the personality dimensions of impulsivity, hostility, and emotional lability. CONCLUSIONS Similar to findings in adults, impaired decision making is associated with suicidal behavior in adolescents. Longitudinal studies are needed to elucidate the temporal relationship between decision-making processes and suicidal behavior and to help frame potential targets for early identification and preventive interventions to reduce youth suicide and suicidal behavior.

What’s the Harm in Asking About Suicidal Ideation?

Both researchers and oversight committees share concerns about patient safety in the study-related assessment of suicidality. However, concern about assessing suicidal thoughts can be a barrier to the development of empirical evidence that informs research on how to safely conduct these assessments. A question has been raised if asking about suicidal thoughts can result in iatrogenic increases of such thoughts, especially among at-risk samples. The current study repeatedly tested suicidal ideation at 6-month intervals for up to 2-years. Suicidal ideation was measured with the Suicidal Ideation Questionnaire Junior, and administered to adolescents who had previously received inpatient psychiatric care. Change in suicidal ideation was tested using several analytic techniques, each of which pointed to a significant decline in suicidal ideation in the context of repeated assessment. This and previous study outcomes suggest that asking an at-risk population about suicidal ideation is not associated with subsequent increases in suicidal ideation.

Adolescent attachment security, family functioning, and suicide attempts

Theories of suicidal behavior suggest that the desire to die can arise from disruption of interpersonal relationships. Suicide research has typically studied this from the individuals perspective of the quality/frequency of their social interactions; however, the field of attachment may offer another perspective on understanding an individuals social patterns and suicide risk. This study examined attachment along with broader family functioning (family adaptability and cohesion) among 236 adolescent psychiatric inpatients with (n = 111) and without (n = 125) histories of suicide attempts. On average, adolescents were 14 years of age and Hispanic (69%). Compared to those without suicide attempts, adolescent attempters had lower self-reported maternal and paternal attachment and lower familial adaptability and cohesion. When comparing all three types of attachment simultaneously in the logistic regression model predicting suicide attempt status, paternal attachment was the only significant predictor. Suicide attempt group was also significantly predicted by self-rated Cohesion and Adaptability; neither of the parent ratings of family functioning were significant predictors. These findings are consistent with the predictions of the Interpersonal Theory of Suicide about social functioning and support the efforts to develop attachment-based interventions as a novel route towards suicide prevention.

Changes in Suicide Rates by Hanging and/or Suffocation and Firearms Among Young Persons Aged 10–24 Years in the United States: 1992–2006

We examined changes in suicide rates among 10-24-year-olds in the United States from 1992 to 2006. The overall suicide rate and the rate by firearms, poisoning, and other methods declined markedly, whereas the hanging/suffocation rate increased significantly from 1992 to 2006. This increase occurred across every major demographic subgroup, but was most dramatic for females.

Risk-Sensitive Decision-Making Deficit in Adolescent Suicide Attempters

OBJECTIVE Suicide among adolescents is a major public health problem. Decision-making deficits may play an important role in vulnerability to suicidal behavior, but few studies have examined decision-making performance in youth at risk for suicide. In this study, we seek to extend recent findings that adolescent suicide attempters process risk evaluations differently than adolescents who have not attempted suicide. METHODS We assessed decision-making in 14 adolescent suicide attempters and 14 non-attempter comparison subjects, ages 15-19, using the Cambridge Gambling Task (CGT). Each participant was also administered a diagnostic interview (Mini-International Neuropsychiatric Interview [MINI]), structured suicide severity measures, and a brief intelligence quotient (IQ) measure. RESULTS After controlling for gender and IQ differences, suicide attempters displayed an elevated risk-taking propensity on the CGT relative to comparison subjects, such that they were more willing to take a large risk with their bank of points, a decision-making style that proves disadvantageous over time. No group differences in the latency or accuracy of decision-making were observed. CONCLUSIONS Adolescents with a history of suicide attempt display increased risk-taking and greater difficulty predicting probable outcomes on the CGT. Such deficits have been associated with dysfunction in the orbitofrontal prefrontal cortex, which supports other studies implicating impaired decision-making among individuals with a history of suicide attempt.

Impulsive Aggression, Delay Discounting, and Adolescent Suicide Attempts: Effects of Current Psychotropic Medication Use and Family History of Suicidal Behavior

OBJECTIVE Impulsive-aggressive behaviors have been consistently implicated in the phenomenology, neurobiology, and familial aggregation of suicidal behavior. The purpose of this study was to extend previous work by examining laboratory behavioral measures of delayed reward impulsivity and impulsive aggression in adolescent suicide attempters and never-suicidal comparison subjects. METHODS Using the Point Subtraction Aggression Paradigm (PSAP) and the Delay Discounting Task (DDQ), the authors examined delay discounting and impulsive aggression in 40 adolescent suicide attempters, ages 13-18, and 40 never-suicidal, demographically matched psychiatric comparison subjects. RESULTS Overall, suicide attempters and comparison subjects performed similarly on the PSAP and DDQ. There was a significant group by current psychotropic medication use interaction (p=0.013) for mean aggressive responses on the PSAP. Group comparisons revealed that attempters emitted more aggressive responses per provocation than comparison subjects, only in those not on psychotropic medication (p=0.049), whereas for those currently treated with psychotropic medication, there were no group differences (p>0.05). This interaction effect was specific to current antidepressant use. Among all subjects, family history of suicidal behavior (suicide or suicide attempt) in first degree relatives was significantly correlated with both delay discounting (r=-0.22, p=0.049), and aggressive responding (r=0.27, p=0.015). Family history of suicidal behavior was associated with delay discounting, but not with aggressive responding on the PSAP, after controlling for relevant covariates. CONCLUSIONS In this study, impulsive-aggressive responding was associated with suicide attempt only in those not being treated with antidepressants. Future work to replicate and extend these findings could have important therapeutic implications for the treatment of depressed suicide attempters, many of whom are affected by impulsive aggression.

Adolescent Mothers’ Perceptions of the Coparenting Relationship With Their Child’s Father: A Function of Attachment Security and Trust

This study used data from 75 adolescent mothers to examine relations among adolescent mothers’ attachment avoidance and anxiety, their ability to trust their child’s father, and their perceptions of the quality of their coparenting relationship with their child’s father. Results suggest that mothers with lower avoidance had more trust for their child’s father and also had coparenting relationships characterized by less conflict and a stronger parenting alliance. Moreover, trust mediated the associations between mother’s avoidance and coparenting quality. In contrast, mothers’ attachment anxiety was not associated with trust for their child’s father or their perceptions of coparenting relationship quality. This study provides evidence that adolescent mothers’ relationship histories may play an important role in the quality of the coparenting relationship they have with their child’s father.

Insecure Attachment and Suicidal Behavior in Adolescents

BACKGROUND Suicide among adolescents is an important public health problem. One risk factor for youth suicidal behavior that has been underexplored is insecure attachment. AIMS To investigate the association between attachment avoidance/anxiety and suicidal behavior in an adolescent sample. METHOD This study examined attachment insecurity in 40 adolescents who had attempted suicide and 40 never-suicidal demographically matched youths. Adolescents completed self-report measures of attachment style, family alliance, and depressive symptoms. RESULTS Suicide attempters reported significantly higher attachment avoidance and anxiety. Attachment avoidance, but not anxiety, predicted suicide attempt status in a conditional logistic regression analysis that controlled for depressive symptoms and family alliance. CONCLUSION Future research should determine the relative utility of attachment insecurity in prospectively predicting suicide attempts and investigate potential mediators and moderators of this association. Implications for clinicians working with suicidal youth with insecure attachment styles are discussed.

Decision-making in adolescents with suicidal ideation: A case-control study

Decision-making deficits have been associated with attempted suicide in adolescents and adults. This study examined Iowa Gambling Task performance in 19 youths with suicidal ideation and 19 never-suicidal comparison subjects. Group differences in decision-making did not persist after controlling for current affective problems and psychotropic medication use. Future research should determine the contribution of decision-making in predicting the transition from suicidal thoughts to suicide attempts.

Age-Related Racial Disparity in Suicide Rates Among US Youths From 2001 Through 2015

This study compares age-specific rates of suicide between black and white youths using data from the Web-based Injury Statistics Query and Reporting System (WISQARS) of the Centers for Disease Control and Prevention.