Department of Child and Adolescent Psychiatry, CHU Charles-Nicolle-CH Le Rouvray, Université Rouen Normandie, 1 Rue de Germont, 76000, Rouen, France.
Unité de Recherche EA4047 (HANDIReSP), University of Versailles Saint-Quentin-en-Yvelines, Versailles, France.
Eur Child Adolesc Psychiatry. 2020 Dec;29(12):1729-1740. doi: 10.1007/s00787-020-01491-x. Epub 2020 Feb 12.
Suicide attempts (SAs) are a public health concern in adolescence. A brief hospitalization is recommended, but access to inpatient wards is often not available. In addition, numerous risk factors for SA recurrence have been identified, but few studies have explored protective factors. Here, we aimed to assess the role of both risk and protective factors on SA relapse in a context of free access to inpatient services. We performed a prospective follow-up study of 320 adolescents who were hospitalized for an SA between January 2011 and December 2014 in France. Assessments at baseline included socio-demographics, clinical characteristics, temperament, reasons for living, spirituality, and coping. Patients were re-evaluated at 6 months and 12 months for depression severity and SA relapse. A total of 135 and 91 patients (78 girls, 12 boys, aged 13-17) were followed up at 6 and 12 months, respectively. At the 12-month follow-up, 28 (30%) subjects had repeated an SA. Adolescents who either had a history of SA or were receiving psychotropic treatment at baseline were at higher risk of recurrence. Several variables had a protective effect: (1) productive coping skills, namely, working hard and achieving, physical recreation, and seeking relaxing diversions; (2) a particular temperament trait, namely, cooperativeness; and (3) having experienced more life events. We also found a significant interaction: the higher the depression score during follow-up, the lower the protective effect of productive coping. Our findings confirm that a history of SA and seeking psychiatric care with medication are risk factors for SA relapse. However, productive coping strategies and cooperativeness are protective factors, and the improvement of such strategies as well as treatment of persisting depression should be a goal of psychotherapy treatment offered to suicidal adolescents.
自杀未遂（SA）是青少年人群的公共健康关注点。建议进行短暂住院治疗，但通常无法获得住院病房的服务。此外，已经确定了许多与 SA 复发相关的风险因素，但很少有研究探索保护因素。在这里，我们旨在评估在可自由获得住院服务的情况下，风险和保护因素对 SA 复发的作用。我们对 2011 年 1 月至 2014 年 12 月期间在法国因 SA 住院的 320 名青少年进行了前瞻性随访研究。基线评估包括社会人口统计学、临床特征、气质、生存理由、精神性和应对方式。在 6 个月和 12 个月时对患者进行抑郁严重程度和 SA 复发的重新评估。共有 135 名和 91 名患者（78 名女孩，12 名男孩，年龄 13-17 岁）分别在 6 个月和 12 个月时进行了随访。在 12 个月的随访中，28 名（30%）患者重复了 SA。基线时有 SA 病史或正在接受精神药物治疗的青少年复发风险更高。有几个变量具有保护作用：（1）有效的应对技能，即努力工作和取得成就、身体娱乐和寻求放松的消遣；（2）一种特殊的气质特征，即合作性；和（3）经历了更多的生活事件。我们还发现了一个显著的相互作用：在随访期间抑郁评分越高，有效的应对方式的保护作用越低。我们的研究结果证实，SA 病史和寻求药物治疗的精神病护理是 SA 复发的风险因素。然而，有效的应对策略和合作性是保护因素，改善这些策略以及治疗持续的抑郁应该是提供给自杀青少年的心理治疗的目标。
