Longitudinal Study of Suicide Attempts in Adolescents

描述（由研究者提供）：在这项竞争性继续申请中，我们建议在最后4年继续随访被认为具有自杀行为高风险的基本完整的样本（n=180）（第5年将用于最终分析和研究结果的传播）。这项研究中的个体被跟踪长达十年，最初被确定为精神病住院后的青少年。随着这一持续的随访期，我们打算解决几个问题，不仅理论上的利益，但也与实际的临床意义。本项目的第一个具体目的是检查在20年代早期至中期，该样本中自杀行为的明显增加，以及自杀行为增加的程度是由重复自杀行为引起的。在这种情况下，我们也感兴趣的是，在这个样本中，自杀行为的终身史与致敏假设（随着时间的推移，重复自杀企图的频率和严重程度增加，自杀企图和离散生活事件之间的关系降低）的一致程度。本研究的第二个目的是检验自杀行为临床特征的预测有效性。具体来说，鉴于事实上，特别是医疗致死性是非常高的加权心理健康专业人员在临床判断的风险，后来的自杀行为，我们感兴趣的是在何种程度上的意图和医疗致死性的自杀企图是预测的发生后的企图，和意图和致死性的后续企图。该项目的最终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）之间的自杀与非自杀，但精神障碍的个人。考虑到文献中有几份关于自杀者非自杀结局不佳的报告，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，并将使用潜在的类轨迹模型来表征不同群体的个人的基础上，他们的自杀意念和行为随着时间的推移。随着时间的推移，自杀行为过程不同的组将在自杀行为的风险和保护因素以及各种非自杀结局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.