Bommersbach Tanner J, Johnson Grace, Pazdernik Vanessa K, Bostwick J Michael, McKean Alastair J S
Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts.
JAMA Psychiatry. 2025 May 14. doi: 10.1001/jamapsychiatry.2025.0673.
The rates of suicide and suicide attempts are rising precipitously among early adolescents aged 10 to 14 years in the US. While suicide attempts in this age group are more common and associated with lower lethality than in older age groups, very little is known about these individuals' long-term social and psychiatric outcomes.
To examine the adult outcomes of individuals making index suicide attempts that came to medical attention between the ages of 10 and 14 years.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort constitutes a subsample (n = 164) of a previously reported retrospective-prospective study examining individuals who made index suicide attempts during a 22-year period (1986-2007) in Olmsted County, Minnesota.
To collect outcome measures, the medical records of all individuals were queried until March 31, 2023, comprising up to 36 years of follow-up data after the index attempt. Measures included current social, psychiatric, and mortality outcomes as well as lifetime measures of psychiatric hospitalizations and repeat suicide attempts. K-means clustering generated adult groupings based on aggregates of psychiatric hospitalizations and repeat attempts. Multivariable logistic regression identified index attempt factors associated with poor adult outcomes.
Of 164 individuals aged 10 to 14 years who made index attempts (128 [78.0%] female; mean [SD] age at index attempt, 13.7 [1.1] years), 3 (1.8%) died on the index attempt. In the follow-up period, no individuals died by suicide. K-means clustering generated a 2-group solution reflecting low (120 [80%]) and high (30 [20%]) rates of adult psychopathology. While a minority of the sample belonged to the high-rate group, characterized by multiple repeat attempts and hospitalizations, the majority had favorable social indicators and fewer reattempts and hospitalizations. Poor adult outcomes were associated with being male (odds ratio, 2.44; 95% CI, 1.00-5.80; P = .04) and having a psychiatric diagnosis prior to the index attempt (odds ratio, 3.27; 95% CI, 1.42-8.07; P = .007).
In this sample of early adolescents with index suicide attempts followed into adulthood, all who died by suicide did so on the index attempt. While a small number of individuals went on to develop chronic severe psychopathology, the majority demonstrated little evidence of long-term impairment. Given this discrepancy, future studies should focus on using risk stratification after index attempts to direct postvention resources toward adolescents more susceptible to poor outcomes.
在美国，10至14岁的青少年自杀率和自杀未遂率正在急剧上升。虽然这个年龄组的自杀未遂比年龄较大的组更常见且致死率更低，但对于这些个体的长期社会和精神状况知之甚少。
研究10至14岁时首次自杀未遂并引起医疗关注的个体成年后的情况。
设计、地点和参与者：这个基于人群的队列是之前一项回顾性-前瞻性研究的子样本（n = 164），该研究调查了明尼苏达州奥尔姆斯特德县在22年期间（1986 - 2007年）首次自杀未遂的个体。
为收集结局指标，查询了所有个体截至2023年3月31日的病历，包括首次自杀未遂后长达36年的随访数据。测量指标包括当前的社会、精神状况和死亡率结局，以及精神科住院和重复自杀未遂的终生测量指标。K均值聚类根据精神科住院和重复自杀未遂的汇总情况生成成年分组。多变量逻辑回归确定了与成年后不良结局相关的首次自杀未遂因素。
在164名10至14岁首次自杀未遂的个体中（128名[78.0%]为女性；首次自杀未遂时的平均[标准差]年龄为13.7[1.1]岁），3名（1.8%）在首次自杀未遂时死亡。在随访期间，没有个体死于自杀。K均值聚类生成了一个两组解决方案，反映出成年精神病理学发生率低（120名[80%]）和高（30名[20%]）的情况。虽然少数样本属于高发生率组，其特征是多次重复自杀未遂和住院，但大多数样本的社会指标良好，重复自杀未遂和住院次数较少。成年后不良结局与男性（优势比，2.44；95%置信区间，1.00 - 5.80；P = 0.04）以及首次自杀未遂前有精神科诊断（优势比，3.27；95%置信区间，1.42 - 8.07；P = 0.007）有关。
在这个随访至成年的首次自杀未遂的青少年样本中，所有死于自杀的个体都是在首次自杀未遂时死亡。虽然少数个体后来发展为慢性严重精神病理学，但大多数个体几乎没有长期损害的证据。鉴于这种差异，未来的研究应侧重于在首次自杀未遂后使用风险分层，以便将干预资源导向更容易出现不良结局的青少年。
