Longitudinal Study of Suicide Attempts in Adolescents

描述(由研究人员提供)：在这项竞争性的延续申请中，我们建议继续跟踪被认为具有自杀行为高风险的基本完好的样本(n=180)最后四年(第五年将用于最终分析和研究结果的传播)。这项研究中的个体已经被跟踪了长达十年，并在精神病住院后最初被确定为青少年。随着这一持续的随访期，我们打算解决几个问题，不仅理论上感兴趣，而且具有实际的临床意义。这个项目的第一个具体目标是检查这个样本在20‘年’S早期到中期自杀行为的明显增加，以及自杀行为的增加在多大程度上是由重复自杀行为来解释的。在这一点上，我们也感兴趣的是，在这个样本中，自杀行为的终生历史在多大程度上符合敏化假说(随着时间的推移，重复自杀企图的频率和严重性不断增加，而自杀企图与离散生活事件之间的关系逐渐减少)。这个项目的第二个目的是检验自杀行为的临床特征的预测有效性。具体地说，考虑到精神健康专业人员在临床上对后来自杀行为风险的判断中特别重视医疗致命性的事实，我们感兴趣的是，自杀未遂的声明意图和医疗致命性在多大程度上可以预测以后的自杀未遂的发生，以及随后的自杀未遂的意图和致命性。这一项目的最后一个具体目标是考察有自杀倾向的人与无自杀倾向但精神受损的个人之间的现实生活(非自杀)结果(例如，社会功能障碍、辍学、工作不稳定、监禁)。鉴于文献中有几篇关于有自杀倾向的个体的非自杀结局不佳的报道，这一预后问题尤为重要。在此背景下，我们认识到自杀个体之间的异质性，并将使用潜在的阶级轨迹模型来表征不同的个体群体，基于他们随着时间的推移的自杀想法和行为的过程。随着时间的推移，自杀行为的过程不同的群体将在自杀行为的风险和保护因素以及他们对各种非自杀结果的风险方面进行对比和表征。

DESCRIPTION (provided by investigator): In this competing continuation application, we propose to continue following for a final four years a largely intact sample (n=180) thought to be at high-risk for suicidal behavior (a fifth year will be devoted to final analyses and dissemination of results of the study). The individuals in this study have been followed for up to ten years and were ascertained initially as adolescents following psychiatric hospitalization. With this continued period of follow-up, we intend to address several issues not only of theoretical interest, but also with practical clinical implications. The first Specific Aim of this project is to examine an apparent increase in suicidal behavior in this sample in the early- to mid-20's, and the degree to which this increase in suicidal behavior is accounted for by repeat suicidal behavior. In this vein, we also are interested in the degree to which lifetime histories of suicidal behavior in this sample are consistent with a sensitization hypothesis (with increasing frequency and severity of repeat suicide attempts over time, and decreasing relationship between suicide attempts and discrete life events). The Second Aim of this project is to examine the predictive validity of the clinical characteristics of suicidal behavior. Specifically, given the fact that medical lethality in particular is weighted very highly among mental health professionals in clinical judgments of the risk for later suicidal behavior, we are interested in examining the degree to which the stated intent and medical lethality of suicide attempts are predictive both of the occurrence of later attempts, and of the intent and lethality of subsequent attempts. The final Specific Aim of this project is to examine the real-life (non-suicidal) outcomes (e.g., social dysfunction, school drop-out, job instability, incarceration) among suicidal as contrasted with non-suicidal but psychiatrically impaired individuals. This issue of prognosis is particularly important given several reports in the literature of poor non-suicidal outcomes among suicidal individuals. In this context, we recognize the heterogeneity among suicidal individuals and will use latent class trajectory models to characterize various groups of individuals based on the course of their suicidal ideation and behavior over time. The groups that differ in the courses of their suicidal behavior over time will be contrasted and characterized in terms of risk and protective factors for suicidal behaviors, as well as their risks for various non-suicidal outcomes.