Frequent follow-up of suicidal youth assessed in the emergency room: Long-term trajectory and predictors of suicidality.

Suicide was the second­leading cause of US deaths in 2018 among 15-24-year-olds. Suicide attempts, a risk factor for completions, and suicide ideation have doubled among pediatric emergency room (ER) patients during the past decade. Borderline Personality Disorder (BPD), a comorbid condition, has a 10% suicide rate. We examined the 4-year outcome of a cohort of suicidal adolescents, many also suffering from BPD and having undergone some form of treatment, to identify baseline factors which could inform intervention that would minimize suicidality 4 years post-discharge. METHODS: We conducted a prospective longitudinal study of suicidality at twelve points (four assessment occasions) for 286 suicidal youth presenting to a pediatric ER, most suffering from BPD, with 36 suicide ratings from baseline to 2-, 6- and 48-month follow-up evaluations. We examined the trajectory and predictors of persisting suicidality. RESULTS: Suicidality rapidly decreased within 2 months post-ER-discharge, subsequently remaining low throughout 48 months. Baseline functioning, female sex, stressful life events and BPD impulsiveness were most predictive of persisting suicidality at 48-month follow-up. CONCLUSION: Most suicidal youth, many meeting BPD criteria, no longer feel suicidal 2 months after ER discharge. Management of participants' baseline poor functioning stressful life events and the impulsiveness component of BPD specifically in females could impact suicidality 4 years later, and guide treatment options. The absence of the BPD cognitive and affective subscales as predictors of suicidality at 4-year follow-up may reflect treatment received. Further investigation of treatment effects is warranted and under way.

Previously suicidal adolescents: predictors of six-month outcome.

OBJECTIVE: To determine the baseline variables, including borderline personality disorder (BPD), associated with the six-month outcome of previously suicidal adolescents (n=263) presenting to an emergency department and treated predominantly as out-patients. METHODS: Multivariate logistic regression was used to analyze the associations between baseline variables and suicidality at six-month follow-up. RESULTS: BPD, previous suicide attempt(s), drug use and female gender were associated with subsequent suicidality. CONCLUSIONS: These findings corroborate previously reported risk factors for recurring suicidality among adolescents and broaden their generalizability to those presenting to an emergency department, many diagnosed with BPD.

Profile of a metropolitan North American immigrant suicidal adolescent population.

OBJECTIVE: Canadian immigrant adolescents have a lower suicide rate than their nonimmigrant peers. We conducted a hypothesis-generating analysis to determine whether this lower rate correlated with level of drug use and (or) with diagnostic and demographic characteristics of Canadian immigrant adolescents presenting to an emergency room for crisis assessment. METHOD: Known risk factors for suicide were compared among immigrant youth, North American youth, and a culturally mixed group of youth at baseline and at 6-month follow-up. RESULTS: The immigrant group was only differentiated by a lower rate of reported drug use. CONCLUSION: The lower rate of reported drug use at the time of crisis may contribute to the lower suicide rate among immigrants.