Duncan Maida, Vogel Alecia C, Ramiah Ashna, Tillman Rebecca, Barch Deanna M, Luby Joan, Hennefield Laura
Washington University School of Medicine, St. Louis, Missouri.
Washington University in St. Louis, St. Louis, Missouri.
JAACAP Open. 2025 Feb 5;3(3):516-526. doi: 10.1016/j.jaacop.2025.01.004. eCollection 2025 Sep.
To understand the additional impact of externalizing diagnoses and specific externalizing symptoms (eg, impulsivity, irritability) on risk for suicidal thoughts and behaviors (STBs) in a sample of youth enriched for depression.
Participants included 219 children from the Pediatric Suicidality Study, which has followed a sample of preschoolers enriched for depression into early adolescence (ages 10-14 years). Semistructured interviews to assess STBs and clinical diagnoses including major depressive disorder (MDD), attention-deficit/hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD) were conducted at preschool age (3-6 years), preadolescence (8-12 years), and 2 years later (10-14 years).
Meeting diagnostic criteria for an externalizing disorder at any study time point was significantly associated with experiencing STBs after the preschool period, even when controlling for comorbid depression (66.7% vs 27.6%; χ = 5.70, = .017). Findings were similar when limiting the analyses to suicidal behaviors only (77.3% vs 44.6%; χ = 4.00, = .045). Analyses examining specific externalizing symptoms found that impulsivity and irritability, but not inattention or defiance, were significantly associated with experiencing STBs across the 2 years between follow-up visits leading into early adolescence (impulsivity: estimate = 0.68, SE = 0.29, χ = 5.47, = .019; irritability: estimate = 0.94, SE = 0.35, χ = 7.39, = .007).
Youth with comorbid depression and an externalizing disorder or externalizing symptoms of irritability or impulsivity may be at an elevated risk of STBs into early adolescence. These findings highlight the importance of early identification and treatment of externalizing disorders and symptoms in addition to treating depression when managing STBs in this population and provide additional potential treatment targets.
了解外化性诊断及特定外化性症状（如冲动、易怒）对抑郁症高发的青少年样本中自杀念头和行为（STB）风险的额外影响。
参与者包括来自儿科自杀倾向研究的219名儿童，该研究追踪了一个抑郁症高发的学龄前儿童样本直至青春期早期（10 - 14岁）。在学龄前（3 - 6岁）、青春期前（8 - 12岁）以及两年后（10 - 14岁）进行了半结构化访谈，以评估STB及临床诊断，包括重度抑郁症（MDD）、注意力缺陷多动障碍（ADHD）和对立违抗障碍（ODD）。
在任何研究时间点符合外化性障碍的诊断标准都与学龄前阶段后出现STB显著相关，即使在控制了共病抑郁症的情况下也是如此（66.7%对27.6%；χ = 5.70，P = .017）。仅将分析限于自杀行为时结果相似（77.3%对44.6%；χ = 4.00，P = .045）。对特定外化性症状的分析发现，冲动和易怒，而非注意力不集中或违抗，与进入青春期早期的两年随访期间出现STB显著相关（冲动：估计值 = 0.68，标准误 = 0.29，χ = 5.47，P = .019；易怒：估计值 = 0.94，标准误 = 0.35，χ = 7.39，P = .007）。
患有共病抑郁症且伴有外化性障碍或易怒或冲动的外化性症状的青少年在青春期早期出现STB的风险可能会升高。这些发现凸显了在该人群中管理STB时，除了治疗抑郁症外，早期识别和治疗外化性障碍及症状的重要性，并提供了额外的潜在治疗靶点。
