Department of Psychology, University of British Columbia, Vancouver, Canada.
Department of Psychiatry, University of British Columbia, Vancouver, Canada.
Eur Child Adolesc Psychiatry. 2022 Jun;31(6):919-927. doi: 10.1007/s00787-021-01724-7. Epub 2021 Feb 1.
Rates of suicide in youth have increased over the last 50 years, yet our ability to predict suicidal behaviours has not significantly improved during this time. Examining predictors of suicide attempt lethality can enhance our understanding of suicidality in youth, yet research has focused on actual medical lethality (the actual danger to life resulting from a suicide attempt) rather than potential lethality (the potential for death that is associated with a suicide attempt). Thus, the aim of the present study was twofold: first, we quantified the percentage of youth for whom the severity of suicide attempt was misclassified by considering only actual lethality; second, we tested whether key variables that predict the actual lethality of suicide attempts also predict the potential lethality of suicide attempts in youth. We examined these questions in a sample of children and adolescents admitted to a psychiatric inpatient unit following a suicide attempt. Over 70% of youth who made serious suicide attempts would have been misclassified by assessments relying on only actual lethality. Although several variables relevant to the construct of actual lethality significantly predicted potential lethality (e.g., male sex, substance use disorder), others did not. In addition, we found that the subset of youth who would have been misclassified as low risk based on actual lethality had a disproportionately high need for healthcare resources due to future hospital admissions. The present study provides evidence to suggest that considering potential lethality may lead to improved detection and prediction of suicide risk in youth, and in doing so supports recent calls to broaden considerations of the lethality associated with suicide attempts.
在过去的 50 年里，青少年的自杀率有所上升，但在此期间，我们预测自杀行为的能力并没有显著提高。研究自杀企图的致死性预测因素可以增强我们对青少年自杀的理解，但研究主要集中在实际医学致死性（自杀企图导致的实际生命危险）上，而不是潜在致死性（与自杀企图相关的潜在死亡危险）上。因此，本研究的目的有两个：首先，我们通过只考虑实际致死性来量化因仅考虑实际致死性而导致自杀未遂严重程度被错误分类的青少年比例；其次，我们测试了预测自杀企图实际致死性的关键变量是否也预测了青少年自杀企图的潜在致死性。我们在一组因自杀企图而被收治入院的儿童和青少年中研究了这些问题。超过 70%的严重自杀企图者会因仅依赖实际致死性的评估而被错误分类。尽管与实际致死性相关的几个变量显著预测了潜在致死性（例如，男性、物质使用障碍），但其他变量没有。此外，我们发现，根据实际致死性被错误分类为低风险的那部分青少年，由于未来的住院治疗，对医疗资源的需求过高。本研究提供了证据表明，考虑潜在致死性可能会提高对青少年自杀风险的检测和预测，从而支持了最近呼吁扩大对自杀企图相关致死性的考虑。
