McKean Alastair J, Pabbati Chaitanya, Bommersbach Tanner J, Geske Jennifer R, Bostwick J Michael
Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN.
Headlight Health, San Diego, CA.
J Acad Consult Liaison Psychiatry. 2024 Nov-Dec;65(6):545-550. doi: 10.1016/j.jaclp.2024.09.003. Epub 2024 Oct 5.
In 2021, suicide was the second leading cause of death in early adolescent Americans ages 10-14. Research into suicidal behavior in this age group is limited. We report on prior psychiatric care, attempt method, and attempt outcomes in a cohort of 164 early adolescents accrued by first suicide attempt coming to medical attention.
Our cohort constitutes a subsample from a previously reported retrospective-prospective study identified through the Rochester Epidemiology Project that recruited individuals making first suicide attempts coming to medical attention (index attempt [IA]) during a 22-year period (1/1/1986-31/12/07). Among 1490 all-age index attempters followed until 12/31/2010, 164 (11.0%) were aged 10-14.
3/164 died on IA (1.8% of the cohort; two females, one male). Nearly half (72/164, 43.9%) had no prior psychiatric history. Females were less likely than males to have seen a mental health provider (P = 0.029) or been prescribed psychiatric medications (P < 0.001) prior to IA. Medication overdose was the most common attempt method in females (81/128, 63.3%), while cutting or piercing wounds were the most common method in males (13/36, 36.1%). Females were significantly more likely than males to overdose (P = 0.001). Of IA survivors, 19.9% (32/161) were initially medically hospitalized, 52.8% (85/161) were psychiatrically hospitalized-initially or in transfer-and 37.2% (60/161) were discharged without hospitalization.
Medication overdoses accounted for over half of all IAs and were significantly more common in females. While IA mortality was low relative to older patients from the all-age-cohort, morbidity was substantial with nearly a fifth of attempts severe enough to warrant medical hospitalization and more than half initial or eventual psychiatric hospitalization. These findings emphasize the importance of both means restriction and identification of early adolescents at risk before they make their first attempt.
2021年，自杀是10至14岁美国青少年早期的第二大死因。对这一年龄组自杀行为的研究有限。我们报告了164名因首次自杀未遂而就医的青少年早期队列中的既往精神科护理、自杀未遂方法及自杀未遂结果。
我们的队列是先前一项回顾性-前瞻性研究的子样本，该研究通过罗切斯特流行病学项目确定，在22年期间（1986年1月1日至2007年12月31日）招募首次自杀未遂并就医的个体（索引未遂[IA]）。在随访至2010年12月31日的1490名全年龄索引未遂者中，164名（11.0%）年龄在10至14岁。
164名中有3名在索引未遂时死亡（占队列的1.8%；两名女性，一名男性）。近一半（72/164，43.9%）既往无精神病史。女性在索引未遂前看心理健康服务提供者（P = 0.029）或接受精神科药物治疗（P < 0.001）的可能性低于男性。药物过量是女性最常见的自杀未遂方法（81/128，63.3%），而切割或刺伤是男性最常见的方法（13/36，36.1%）。女性药物过量的可能性显著高于男性（P = 0.001）。在索引未遂幸存者中，19.9%（32/161）最初住院治疗，52.8%（85/161）最初或转院后接受精神科住院治疗，37.2%（60/161）出院时未住院。
药物过量占所有索引未遂的一半以上，且在女性中更为常见。虽然索引未遂死亡率相对于全年龄队列中的老年患者较低，但发病率较高，近五分之一的未遂严重到需要住院治疗，超过一半最初或最终接受精神科住院治疗。这些发现强调了限制自杀手段以及在青少年首次自杀未遂前识别高危青少年的重要性。
