Longitudinal Study of Suicide Attempts in Adolescents

描述（由研究者提供）：在这个竞争性的继续申请中，我们建议在最后四年继续跟踪一个基本完整的样本（n=180），这些样本被认为有自杀行为的高风险（第五年将用于最终分析和研究结果的传播）。本研究中的个体已被跟踪长达十年，并在精神病住院治疗后最初被确定为青少年。在这段持续的随访期间，我们打算解决几个问题，不仅是理论上的兴趣，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在20岁出头到25岁中期的样本中自杀行为的明显增加，以及这种自杀行为增加的程度是由重复自杀行为造成的。在这种情况下，我们也对该样本中自杀行为的一生历史在多大程度上符合敏化假设感兴趣（随着时间的推移，重复自杀企图的频率和严重程度不断增加，自杀企图与离散生活事件之间的关系逐渐减弱）。该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。具体来说，考虑到医疗致死率在心理健康专业人员对后期自杀行为风险的临床判断中权重很高，我们感兴趣的是研究自杀企图的陈述意图和医疗致死率在多大程度上预测了后期企图的发生，以及后续企图的意图和致死率。这个项目的最后一个具体目标是检查现实生活中（非自杀）的结果（例如，社会功能障碍，辍学，工作不稳定，监禁）在自杀和非自杀但精神受损的个体中。鉴于文献中关于自杀个体的不良非自杀结果的几篇报道，预后问题尤为重要。在这种情况下，我们认识到自杀个体之间的异质性，并将使用潜在阶级轨迹模型来描述不同群体的个体，基于他们的自杀意念和行为随时间的变化。随着时间的推移，在自杀行为过程中有所不同的群体将会在自杀行为的风险和保护因素以及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.