Czyz Ewa K, King Cheryl A
a Departments of Psychiatry and Psychology , University of Michigan.
J Clin Child Adolesc Psychol. 2015;44(1):181-93. doi: 10.1080/15374416.2013.836454. Epub 2013 Sep 30.
A period of particularly high risk for suicide attempts among adolescent inpatients is within 12 months after discharge. However, little is known about longitudinal trajectories of suicidal ideation in this high-risk group and how these relate to posthospitalization suicide attempts and rehospitalizations. Our objectives were to identify these trajectories and examine their relationships with posthospitalization psychiatric crises. We also examined predictors of trajectory group membership. Participants (N = 376; ages 13-17; 72% female) were assessed at hospitalization and 3, 6, and 12 months later. Trajectory groups, and their predictors, were identified with latent class growth modeling. We used logistic regression to examine associations between trajectory groups and likelihood of suicide attempts and rehospitalization, controlling for attempt history. Three trajectory groups were identified: (a) subclinical ideators (31.6%), (b) elevated ideators with rapidly declining ideation (57.4%), and (c) chronically elevated ideators (10.9%). Adolescents in the chronically elevated ideation group had 2.29, confidence interval (CI) [1.08, 4.85], p = .03, and 4.15, CI [1.65, 10.44], p < .01, greater odds of attempting suicide and 3.23, CI [1.37, 7.69], p = .01, and 11.20, CI [4.33, 29.01], p < .001, greater odds of rehospitalization relative to rapidly declining and subclinical groups, respectively. Higher baseline hopelessness was associated with persisting suicidal ideation. Results suggest that suicidal ideation severity at hospitalization may not be an adequate marker for subsequent suicidal crises. It is important to identify adolescents vulnerable to persisting suicidal ideation, as they are at highest risk of psychiatric crises. Addressing hopelessness may facilitate faster declines in ideation after hospitalization. Results also highlight a need for consistent monitoring of these adolescents' suicidal ideation after discharge.
青少年住院患者自杀未遂的一个特别高危时期是出院后的12个月内。然而，对于这个高危群体中自杀意念的纵向轨迹以及这些轨迹与出院后自杀未遂和再次住院的关系，我们知之甚少。我们的目标是确定这些轨迹，并研究它们与出院后精神危机的关系。我们还研究了轨迹组成员的预测因素。研究对象（N = 376；年龄13 - 17岁；72%为女性）在住院时以及3个月、6个月和12个月后接受评估。通过潜在类别增长模型确定轨迹组及其预测因素。我们使用逻辑回归来检验轨迹组与自杀未遂和再次住院可能性之间的关联，并控制自杀未遂史。确定了三个轨迹组：（a）亚临床意念者（31.6%），（b）意念迅速下降的意念增强者（57.4%），以及（c）长期意念增强者（10.9%）。与意念迅速下降组和亚临床组相比，长期意念增强组的青少年自杀未遂的几率分别高2.29倍，置信区间（CI）[1.08, 4.85]，p = 0.03，以及高4.15倍，CI [1.65, 10.44]，p < 0.01；再次住院的几率分别高3.23倍，CI [1.37, 7.69]，p = 0.01，以及高11.20倍，CI [4.33, 29.01]，p < 0.001。较高的基线绝望感与持续的自杀意念相关。结果表明，住院时自杀意念的严重程度可能不是后续自杀危机的充分指标。识别易出现持续自杀意念的青少年很重要，因为他们面临精神危机的风险最高。解决绝望感可能有助于住院后意念更快下降。结果还凸显了出院后持续监测这些青少年自杀意念的必要性。
