The Treatment of Adolescent Suicide Attempters study (TASA): predictors of suicidal events in an open treatment trial.
The Treatment of Adolescent Suicide Attempters study (TASA): predictors of suicidal events in an open treatment trial.
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DOI：
10.1097/chi.0b013e3181b5dbe4
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发表时间：
2009-10
影响因子：
13.3
通讯作者：
Turner JB
中科院分区：
文献类型：
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作者：
Brent DA;Greenhill LL;Compton S;Emslie G;Wells K;Walkup JT;Vitiello B;Bukstein O;Stanley B;Posner K;Kennard BD;Cwik MF;Wagner A;Coffey B;March JS;Riddle M;Goldstein T;Curry J;Barnett S;Capasso L;Zelazny J;Hughes J;Shen S;Gugga SS;Turner JB
在一项公开治疗试验中，确定抑郁症青少年自杀未遂者自杀事件和企图的预测因素。最近有自杀企图并患有单相抑郁症的青少年（n=124）被随机（n=22）或在三种情况下进行选择（n=102）。两名参与者在治疗分配前退出。剩下的124名青少年分别接受了针对有自杀倾向的青少年的专门心理治疗（n=17）、药物治疗（n=14）或综合治疗（n=93）。参与者在服药后6个月随访自杀事件的发生率、时间和预测因素（自杀企图或急性自杀意念需要紧急转诊）。在6个月的随访中，自杀事件和自杀企图的发病风险分别为0.19和0.12，发生自杀事件的中位时间为44天。较高的自评抑郁程度、自杀意念、家庭收入、较高的自杀企图次数、较低的自杀企图最大致死率、性虐待史和较低的家庭凝聚力预测了自杀的发生，并且事件发生的时间较早，对自杀企图的结果也有类似的发现。自杀意念的缓慢下降与自杀事件的发生有关。在这项公开试验中，6个月自杀事件和再次自杀的发病风险低于其他可比样本，这表明这种干预措施应进一步研究。重要的治疗目标包括自杀意念、家庭凝聚力和以前虐待的后遗症。由于40%的事件发生在摄入后第4周，因此强调安全计划和在治疗早期增加治疗接触可能是有必要的。
To identify the predictors of suicidal events and attempts in depressed adolescent suicide attempters treated in an open treatment trial. Adolescents who had made a recent suicide attempt and had unipolar depression (n=124) were either randomized (n=22) or given a choice (n=102) among three conditions. Two participants withdrew prior to treatment assignment. The remaining 124 youth received either: a specialized psychotherapy for suicide attempting adolescents (n=17), a medication algorithm (n=14), or the combination (n=93). The participants were followed up 6 months after intake with respect to rate, timing, and predictors of a suicidal event (attempt or acute suicidal ideation necessitating emergency referral). The morbid risks of suicidal events and attempts upon 6-month follow-up were 0.19 and 0.12, respectively, with a median time to event of 44 days. Higher self-rated depression, suicidal ideation, family income, greater number of previous suicide attempts, lower maximum lethality of previous attempt, history of sexual abuse, and lower family cohesion predicted the occurrence, and earlier time to event, with similar findings for the outcome of attempts. A slower decline in suicidal ideation was associated with the occurrence of a suicidal event. In this open trial, the 6-month morbid risks for suicidal events and for re-attempts were lower than in other comparable samples, suggesting that this intervention should be studied further. Important treatment targets include suicidal ideation, family cohesion, and sequelae of previous abuse. Because 40% of events occurred with 4 weeks of intake, an emphasis on safety planning and increased therapeutic contact early in treatment may be warranted.