FAMILY RISK FACTORS FOR ADOLESCENT SUICIDAL BEHAVIOR

拟议研究的目的是确定家庭风险因素

The purpose of the proposed study is to identify family risk factors that are predictive of recurrent suicide attempts and suicide ideation over a two-year period following a suicide attempt, among adolescents hospitalized in a psychiatric unit. Attempted suicide during adolescence is a mental health problem of significant concern, both because it increases the risk of completed suicide, and because it may set the stage for continued self-destructive behavior. Empirical research and clinical reports have indicated that disturbances within families, especially rejection by parents, poor family communication and problem-solving, and parental psychopathology, may be important risk factors for youth suicidal behavior. However, prior studies of family factors have been of only limited value in documenting the process by which these factors may influence suicidal behavior, because they have typically been cross- sectional, they have generally relied on adolescent self-report data, and they have not investigated lineages among various family risk factors or between family and intrapersonal risk factors. A prospective longitudinal design will be utilized to follow 90 adolescents (ages 13-18) who are hospitalized immediately following a suicide attempt, as well as their parents. These families will be assessed during the hospitalization, and at six-month intervals following discharge. In addition, a comparison group of 60 hospitalized adolescents with no history of a suicide attempt will be recruited, along with their parents. These adolescents will be matched on demographic and diagnostic characteristics with the first 60 suicidal youth who are recruited, and this comparison group will be assessed during their hospitalization, only. Assessment of adolescents and parents will focus on four levels of potential risk variables that are hypothesized to play a part in the process by which suicidal behavior develops and persists: predisposing vulnerabilities, including temperament, parental psychopathology, and childhood stresses; current indices of adjustment, including youth psychopathology, youth's working models of their attachment to parents, and observed as well as reported indices of the current parent-adolescent relationship; current youth coping resources and stresses; and indices of hope for the future. Youth will also report their daily activities in weekly telephone assessments conducted the first four weeks following discharge from the hospital. The course of repeated suicide attempts and of suicidal ideation over the follow-up period will be analyzed using survival analysis and longitudinal growth curves. The degree to which the risk variables, as well as changes in the risk variables over time, are predictive of suicide attempts and suicide ideation over the follow-up period will be examined. A hypothesized model of the causal pathways among these factors in the development of suicidal behavior will be tested.