Search

Background: Stress exposure contributes to the onset, maintenance, and recurrence of major depressive disorder (MDD) in adolescents. However, the precise stress facets (e.g. chronicity, domain) most strongly linked to outcomes at different stages along the depression severity continuum remain unclear. Across two studies, chronic and episodic stressors were comprehensively assessed among: (a) healthy youth with (High‐Risk [HR]) and without (Low‐Risk [LR]) a maternal history of MDD and (b) adolescents with current MDD and suicide ideation and healthy controls (HC). Method: Study 1 included LR (n = 65) and HR (n = 22) 12‐ to 14‐year‐olds (49 females; 56.32%) with no lifetime history of mental disorders. Study 2 enrolled 87 mid‐to‐late adolescents (64 females; 73.56%), including 57 MDD youth from a short‐term intensive treatment service and 30 HCs from the community. All depressed youth reported recent suicide ideation; some had no lifetime history suicide attempts (SI; n = 31) and others reported at least one past year attempt (SA; n = 26). The Life Events and Difficulties Schedule was used to capture stressor severity in both studies. Results: We used multiple linear regression models that adjusted for demographic and clinical covariates. Being in the HR versus LR group was associated with more severe chronic (β =.22, CI95 = 0.01–0.42, p =.041), independent (β =.34, CI95 = 0.12–0.56, p =.003), and interpersonal (β =.23, CI95 = 0.004–0.45, p =.047) stress severity. By contrast, the MDD group reported significantly more severe chronic (β =.62, CI95 = 0.45–0.79, p <.001) and dependent (β =.41, CI95 = 0.21–0.61, p <.001) stress than the HC group, but not independent (p =.083) stress. Stress severity did not differ between recent attempters versus youth who reported suicide ideation alone (SA vs. SI contrast). However, the SA group reported a higher rate of targeted rejection events (RR = 3.53, CI95 = 1.17–10.70, p =.026). Conclusions: Our findings clarify the stressor features that may most strongly contribute to adolescent depression and its clinical correlates at two important points along depression's clinical course. [ABSTRACT FROM AUTHOR]

Background: Suicide is a major public health crisis among youth. Several prominent theories, including the Interpersonal Theory of Suicide (IPTS), aim to characterize the factors leading from suicide ideation to action. These theories are largely based on findings in adults and require testing and elaboration in adolescents. Methods: Data were examined from high‐risk 13–18‐year‐old adolescents (N = 167) participating in a multi‐wave, longitudinal study; 63% of the sample exhibited current suicidal thoughts or recent behaviors (n = 105). The study included a 6‐month follow‐up period with clinical interviews and self‐report measures at each of the four assessments as well as weekly smartphone‐based assessments of suicidal thoughts and behaviors. Regression and structural equation models were used to probe hypotheses related to the core tenets of the IPTS. Results: Feelings of perceived burdensomeness were associated with more severe self‐reported suicidal ideation (b = 0.58, t(158) = 7.64, p <.001). Similarly, burdensomeness was associated with more frequent ideation based on weekly smartphone ratings (b = 0.11, t(1460) = 3.41, p <.001). Contrary to IPTS hypotheses, neither feelings of thwarted belongingness, nor interactions between burdensomeness and thwarted belongingness were significantly associated with ideation (ps >.05). Only elevated depression severity was associated with greater odds of suicide events (i.e., suicide attempts, psychiatric hospitalizations, and/or emergency department visits for suicide concerns) during the follow‐up period (OR = 1.83, t(158) = 2.44, p =.01). No effect of acquired capability was found. Conclusions: Perceptions of burdensomeness to others reflect a critical risk factor for suicidal ideation among high‐risk adolescents. Null findings with other IPTS constructs may suggest a need to adopt more developmentally sensitive models or measures of interpersonal and acquired capability risk factors for youth. Refining methods and theoretical models of suicide risk may help improve the identification of high‐risk cases and inform clinical intervention. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Non‐suicidal self‐injury (NSSI) is common among adolescents receiving inpatient psychiatric treatment and the months post‐discharge is a high‐risk period for self‐injurious behavior. Thus, identifying predictors that shape the course of post‐discharge NSSI may provide insights into ways to improve clinical outcomes. Accordingly, we used machine learning to identify the strongest predictors of NSSI trajectories drawn from a comprehensive clinical assessment.The study included adolescents (N = 612; females n = 435; 71.1%) aged 13–19‐years‐old (M = 15.6, SD = 1.4) undergoing inpatient treatment. Youth were administered clinical interviews and symptom questionnaires at intake (baseline) and before termination. NSSI frequency was assessed at 1‐, 3‐, and 6‐month follow‐ups. Latent class growth analyses were used to group adolescents based on their pattern of NSSI across follow‐ups.Three classes were identified: Low Stable (n = 83), Moderate Fluctuating (n = 260), and High Persistent (n = 269). Important predictors of the High Persistent class in our regularized regression models (LASSO) included baseline psychiatric symptoms and comorbidity, past‐week suicidal ideation (SI) severity, lifetime average and worst‐point SI intensity, and NSSI in the past 30 days (bs = 0.75–2.33). Only worst‐point lifetime suicide ideation intensity was identified as a predictor of the Low Stable class (b = −8.82); no predictors of the Moderate Fluctuating class emerged.This study found a set of intake clinical variables that indicate which adolescents may experience persistent NSSI post‐discharge. Accordingly, this may help identify youth that may benefit from additional monitoring and support post‐hospitalization. [ABSTRACT FROM AUTHOR]

Background Suicidal thoughts and behaviors are major public health concerns in youth. Unfortunately, knowledge of reliable predictors of suicide risk in adolescents is limited. Promising research using a death stimuli version of the Implicit Association Test (Death IAT) indicates that stronger identification with death differs between adults with and without a history of suicidal thoughts and behaviors and uniquely predicts suicide ideation and behavior. However, research in adolescents is lacking and existing findings have been mixed. This study extends previous research by testing whether implicit identification with death predicts changes in suicide ideation during psychiatric treatment in adolescents. Methods Participants included 276 adolescents, ages 13-19, admitted to a short-term residential treatment program. At hospital admission and discharge, adolescents completed the Death IAT and measures of recent suicidal thoughts. Results At admission, implicit identification with death was associated with recent suicide ideation, but did not differ between those who engaged in prior suicidal behavior and those who did not. Prospectively, adolescents' implicit identification with death at admission significantly predicted their suicide ideation severity at discharge, above and beyond explicit suicide ideation. However, this effect only was significant for adolescents with longer treatment stays (i.e., more than 13 days). Conclusions Implicit identification with death predicts suicidal thinking among adolescents in psychiatric treatment. Findings clarify over what period of time implicit cognition about death may predict suicide risk in adolescents. [ABSTRACT FROM AUTHOR]

Suicidal and nonsuicidal self-injurious thoughts and behaviors (SITBs) among youth are major public health concerns. Although a growing body of research has focused on the complex association between nonsuicidal and suicidal self-injury, the temporal relationship between these two classes of behaviors is unclear. The current study addresses this empirical gap by examining the course of SITBs in adolescents receiving outpatient (N = 106; 82.1 % female) and inpatient (N = 174; 75.9 % female) treatment. SITBs (co-occurrence, age-of-onset, and time lag between SITBs) and major psychiatric disorders were assessed at a single time point with well-validated structured interviews. Adolescents in both clinical samples reported high co-occurrence of SITBs: most adolescents reported both lifetime nonsuicidal self-injury (NSSI) and suicidal thoughts. A similar temporal pattern of SITBs was reported in the two samples: thoughts of NSSI and suicide ideation had the earliest age-of-onset, followed by NSSI behaviors, suicide plans, and suicide attempts. However, the age-of-onset for each SITB was younger in the inpatient sample than in the outpatient sample. In terms of time lag between SITBs, suicide ideation occurred on average before initial engagement in NSSI, suggesting that pathways to NSSI and suicidal behavior may occur simultaneously rather than in succession from nonsuicidal to suicidal self-injury. Results also indicated that the time to transition between SITBs was relatively fast, and that a key period for intervention and prevention is within the first 6-12 months after the onset of suicidal thinking. Taken together, these findings have important implications for understanding the time-lagged relationship between nonsuicidal and suicidal self-injury. [ABSTRACT FROM AUTHOR]

Background Adolescent depression and suicide are pressing public health concerns, and identifying key differences among suicide ideators and attempters is critical. The goal of the current study is to test whether depressed adolescent suicide attempters report greater anhedonia severity and exhibit aberrant effort–cost computations in the face of uncertainty. Methods Depressed adolescents ( n =101) ages 13–19 years were administered structured clinical interviews to assess current mental health disorders and a history of suicidality (suicide ideators=55, suicide attempters=46). Then, participants completed self-report instruments assessing symptoms of suicidal ideation, depression, anhedonia, and anxiety as well as a computerized effort–cost computation task. Results Compared with depressed adolescent suicide ideators, attempters report greater anhedonia severity, even after concurrently controlling for symptoms of suicidal ideation, depression, and anxiety. Additionally, when completing the effort–cost computation task, suicide attempters are less likely to pursue the difficult, high value option when outcomes are uncertain. Follow-up, trial-level analyses of effort–cost computations suggest that receipt of reward does not influence future decision-making among suicide attempters, however, suicide ideators exhibit a win–stay approach when receiving rewards on previous trials. Limitations Findings should be considered in light of limitations including a modest sample size, which limits generalizability, and the cross-sectional design. Conclusions Depressed adolescent suicide attempters are characterized by greater anhedonia severity, which may impair the ability to integrate previous rewarding experiences to inform future decisions. Taken together, this may generate a feeling of powerlessness that contributes to increased suicidality and a needless loss of life. [ABSTRACT FROM AUTHOR]

For several decades, resting electroencephalogram (EEG) alpha oscillations have been used to characterize neurophysiological alterations related to major depressive disorder. Prior research has generally focused on frontal alpha power and asymmetry despite resting alpha being maximal over posterior electrode sites. Research in depressed adults has shown evidence of hemispheric asymmetry for posterior alpha power, however, the resting posterior alpha-depression link among adolescents remains unclear. To clarify the role of posterior alpha among depressed adolescents, the current study acquired eyes-closed 128-channel resting EEG data from 13 to 18 year-old depressed (n = 31) and healthy (n = 35) female adolescents. Results indicated a significant group by hemisphere interaction, as depressed adolescents exhibited significantly larger posterior alpha (i.e., lower brain activity) over the right versus left hemisphere, whereas healthy adolescents showed no hemispheric differences. Relatively greater alpha over the right versus left hemisphere correlated with depression symptoms, anhedonia symptoms, rumination, and self-criticism. Further, depressed adolescents had reduced overall posterior alpha compared to healthy youth; though, no associations with symptoms and related traits emerged. Resting posterior alpha may be a promising neurophysiological index of adolescent depression, and more broadly, may relate to risk factors characterized by enhanced perseveration. • Depressed youth are characterized by increased resting posterior alpha asymmetry. • Depressed youth exhibit reduced overall posterior alpha compared to healthy youth. • Posterior alpha asymmetry correlates with depression-related symptoms and traits. [ABSTRACT FROM AUTHOR]

Adolescent non-suicidal self-injury (NSSI) and suicidality are serious health concerns; however, factors that contribute to the transition from NSSI to suicide ideation and suicide attempts are unclear. To address this gap, we investigated whether demographic characteristics, child maltreatment, and psychiatric factors are associated with the level suicidality among adolescents with a history of self-injury. Participants were three groups of adolescent inpatient self-injurers ( n = 397, 317 female), aged 13–18 years ( M = 15.44, SD = 1.36): (a) non-ideators ( n = 96; no current suicide ideation and no lifetime suicide attempts), (b) suicide ideators ( n = 149; current ideation and no lifetime attempts), and (c) suicide attempters ( n = 152; current ideation and at least one lifetime attempt). Participants completed interviews assessing psychiatric diagnoses, suicidality, and NSSI characteristics, as well as questionnaires on childhood trauma, psychiatric symptoms, and risky behavior engagement. Depression severity was associated with greater odds being a suicide ideator ( p < 0.001, OR = 1.04) and an attempter ( p < 0.001, OR = 1.05) compared to a non-ideator. Suicide attempters used more NSSI methods and reported greater risky behavior engagement than non-ideators ( p = 0.03, OR = 1.29 and p = 0.03, OR = 1.06, respectively) and ideators ( p = 0.015, OR = 1.25 and p = 0.04, OR = 1.05, respectively); attempters used more severe NSSI methods (e.g., burning). Our results identify a wide range of risk markers for increasing lethality in a sample at high risk for suicide mortality; future research is needed to refine risk assessments for adolescent self-injurers and determine the clinical utility of using risk markers for screening and intervention. [ABSTRACT FROM AUTHOR]