Suicidal children grow up: ego functions associated with suicide attempts.

OBJECTIVE: To evaluate the relations between suicidal behavior in children and ego functions including impulse control, reality testing, and ego mechanisms of defense. METHOD: One hundred thirty-three children were assessed initially and at a 6- to 8-year follow-up for levels of reality testing and impulse control and frequency of use of several ego mechanisms of defense. Associations between suicidal ideation and suicide attempts at the initial assessment and at follow-up were analyzed with regard to ego functions. RESULTS: Specific ego functions, such as impulsivity, poor reality testing, and ego mechanisms of defense such as projection, regression, compensation, and reaction formation were positively associated with suicide attempts. Repression was a protective factor to prevent suicide attempts in the follow-up period. CONCLUSIONS: The results suggest that ego functions are related to behavior of consequence and are useful in the identification of children at risk for suicidal behavior.

Suicidal children grow up: suicidal episodes and effects of treatment during follow-up.

OBJECTIVES: This paper describes risk for first recurrent suicidal episodes in follow-up of suicidal child psychiatric inpatients. It identifies relations between suicide attempts in follow-up and psychosocial and psychopharmacological treatments. METHODS: First suicidal episodes involving either suicidal ideation or a suicide attempt in a 6 to 8 year follow-up period were rated for 69 child psychiatric inpatients and 64 children selected from the community. Psychiatric treatments were determined from reports from multiple sources. RESULTS: Forty-five percent of 133 subjects reported a suicidal episode during follow-up. Children who reported suicidal ideation or a suicide attempt were greater than twice as likely to report a suicidal episode in follow-up than were children from the community. Children treated with antidepressants in follow-up were more likely to attempt suicide than were those not treated with antidepressants. CONCLUSIONS: Close follow-up of suicidal children is warranted to identity risk and to intervene to prevent suicidal episodes. Lack of efficacy of naturalistic treatments implies that controlled treatment studies are needed to determine effective intervention for suicidal children.

Suicidal children grow up: rates and psychosocial risk factors for suicide attempts during follow-up.

OBJECTIVE: Rates and psychosocial risk factors for suicide attempts during a 6 to 8-year follow-up period were compared for 25 predominantly prepubertal inpatient suicide attempters, 28 inpatient suicidal ideators, 16 nonsuicidal inpatients, and 64 nonpatients. METHOD: Standard research instruments were used to interview subjects and parents. Cox proportional hazard regression analyses were used to identify risk factors for a suicide attempt in the follow-up. RESULTS: No deaths occurred during follow-up. Suicide attempters were six times and suicidal ideators were three times more likely than were nonpatients to attempt suicide during follow-up. Poor social adjustment and mood disorder close to a recurrent suicide attempt were the strongest risk factors. CONCLUSIONS: Risk assessment should focus on identifying symptoms of mood disorders and impaired social adjustment in children with histories of suicide attempts and psychiatric hospitalization.

Suicidal children grow up: psychiatric treatment during follow-up period.

This study compares the treatment course during a 6- to 8-year follow-up period of 53 suicidal preadolescent and young adolescent psychiatric inpatients with those of 16 nonsuicidal psychiatric inpatients and 64 nonpatients selected from a community. The three groups of subjects were matched on demographic characteristics. All 69 patients and 10 (15.6%) nonpatients received treatment during follow-up. Treatment course during follow-up for suicidal patients was significantly longer, earlier, and more intensive than for the nonpatient controls. Fifty-five percent of 20 subjects who attempted suicide during follow-up were in treatment at the time of the suicide attempt.

Suicidal children grow up: demographic and clinical risk factors for adolescent suicide attempts.

This longitudinal study reports rates and demographic and clinical risk factors for adolescent suicide attempts during a 6- to 8-year follow-up period of an initial sample of 106 preadolescent and young adolescent psychiatric inpatients and 101 preadolescent and young adolescent nonpatients. Survival analysis was used to evaluate risk for a first suicide attempt in the follow-up period for 133 subjects who were interviewed. No deaths occurred. Suicidal inpatients, compared with nonpatients, had earlier first suicide attempts in the follow-up period. Adolescents who attempted suicide in the follow-up period were seven times more likely to have a mood disorder during the follow-up period than those who did not attempt suicide. Implications for clinical practice and research are discussed.