Posttraumatic stress disorder in peers of adolescent suicide victims: predisposing factors and phenomenology.

OBJECTIVE: To examine the factors predisposing to posttraumatic stress disorder (PTSD) in peers of adolescent suicide victims. METHOD: One hundred forty-six adolescents who were the friends of 26 suicide victims were studied. Five percent (n = 8) developed PTSD after exposure to suicide. These 8 subjects with PTSD were compared to the remainder of the exposed subjects (n = 138). RESULTS: Subjects with PTSD were more likely than those without PTSD to have had a history of substance abuse, agoraphobia, and suicide attempts. Subjects who developed PTSD were more likely to have developed a new-onset depression, to have more severe grief, and to have been closer to the suicide victim. Subjects with PTSD tended to have more severe exposure to suicide and came from discordant households with a history of disruptions in key relationships. The 8 subjects who developed PTSD were compared to 38 subjects who developed new-onset depression but not PTSD. Those with PTSD were more likely to have had past substance abuse, prior suicide attempts, family history of panic disorder, a history of parent-child disruption, and a history of loss. Symptoms of intrusive visual images, hypervigilance, and avoidance of reminders discriminated subjects who had PTSD from new-onset depressives without PTSD. CONCLUSIONS: PTSD is an expectable outcome in youth exposed to suicide. Further work is required to differentiate symptoms of depression from PTSD.

Major depression or uncomplicated bereavement? A follow-up of youth exposed to suicide.

OBJECTIVE: To determine whether the depressive reactions experienced by youth exposed to suicide were uncomplicated bereavement or major depression by examining the longitudinal risk of recurrent major depression. METHOD: The 121 friends and acquaintances of 26 adolescent suicide victims were followed up 1 to 18 months after an initial interview that took place around 6 months after the death of the suicide victim. A demographically similar group of 138 unexposed controls was also followed up. RESULTS: The median duration of depression in the 37 subjects who became depressed after exposure was 8 months. The exposed group, compared with controls, had a higher rate of incident depression (RR = 1.7, 95% Cl = 1.0-2.8) during the follow-up period, even after adjustment for previous history of depression and other risk factors for depression. Within the group of exposed subjects, the rate of depression on follow-up was highest in those who developed a depressive disorder before exposure to suicide, intermediate in those who developed depression after exposure, and lowest in those who were not depressed at the first interview after exposure. There was no evidence of an increased incidence of suicide attempts in the exposed group relative to the unexposed controls on follow-up. CONCLUSIONS: The depressive reactions observed in youth exposed to suicide are most consistent with major depressive episodes on the basis of course and risk of recurrence. Exposure to suicide was associated with an increased risk of recurrent depression but not with an increased long-term risk of suicidal behavior.

Familial risk factors for adolescent suicide: a case-control study.

Sixty-seven adolescent suicide victims and 67 demographically matched living controls were compared as to family constellation, familial stressors and familial loading for psychopathology. Suicide victims were less likely to have lived with both biological parents, were more likely to be exposed to stressors such as parent-child discord, physical abuse and residential instability and showed greater familial loading for depression and substance abuse. Multivariate analyses showed that family history of both depression and substance abuse and lifetime history of parent-child discord were most closely associated with adolescent suicide. Children who are the offspring of parents with depression or substance abuse should be psychiatrically screened. Family interventions to decrease discord may also be helpful in decreasing the risk of adolescent suicide.

Bereavement or depression? The impact of the loss of a friend to suicide.

OBJECTIVE: To determine whether the depressive reactions experienced by youth exposed to suicide were uncomplicated bereavement or bona fide major depression. METHOD: In a sample of 146 friends and acquaintances of 26 adolescent suicide victims, 43 (29%) developed a depressive episode subsequent to exposure to suicide, 18 were depressed before exposure, and 85 were never depressed. The three groups were compared. RESULTS: Those who became depressed after exposure were similar to those who were depressed before exposure. Both depressed groups differed from the nondepressed exposed group with respect to functional impairment, depressive symptom pattern and severity, convergent validity with other measures of depression, personal and family history of depression, and stressful life events. Previous depressives showed greater comorbidity with nonaffective disorders than those who became depressed after exposure. Those who became depressed after exposure compared with both the previous and nondepressive had a closer relationship with the suicide victims, showed more severe grief, and showed more intense exposure to the suicide. CONCLUSIONS: Depressive reactions occurring after exposure to suicide appear to be bona fide major depression, occurring as a complication of bereavement. Youth exposed to suicide should be carefully screened and followed up. Should a symptomatic picture of depression and functional impairment ensue, such exposed youth should be treated accordingly for a major depressive episode.

Psychiatric impact of the loss of an adolescent sibling to suicide.

Twenty-five adolescent siblings of 20 adolescent suicide victims were psychiatrically assessed 6 months after the suicide, and compared to 25 demographically matched controls. Siblings were much more likely to show a new-onset major depression subsequent to exposure to suicide. New-onset depression was associated with previous psychiatric disorder, family history of any psychiatric disorder, and family history of major depression. Mothers of suicide victims, compared to the mothers of controls, were also more likely to be depressed 6 months after the suicide of their child. The development of a family-based intervention for families of adolescent suicides is recommended.

Psychiatric sequelae to the loss of an adolescent peer to suicide.

OBJECTIVE: This study was designed to learn whether friends and acquaintances of suicide victims were at increased risk for depression, post-traumatic stress disorder, and suicidal behavior after exposure to suicide. METHOD: The social networks of 26 adolescent suicide victims, consisting of 146 adolescents, were interviewed 7 months after the death of the suicide victim and compared with 146 matched, unexposed controls. RESULTS: The rates of these disorders that had onset after exposure were elevated in the exposed group vs. controls: major depression, post-traumatic stress disorder, suicidal ideation with a plan or an attempt, but not suicidal attempts. Almost all of those exposed youth who developed new-onset suicidality did so in the context of a new-onset depressive episode. The majority of these new-onset depressive disorders began within 1 month of exposure. CONCLUSION: Postvention programs not only should focus on the prevention of imitation of suicidal behavior, but also should provide longer term follow-up for potentially bereaved and depressed youth exposed to suicide.