Prior Suicide Attempts Associated With Poorer Clinical, Functional Outcomes in Adolescents, Young Adults

According to data published in the Journal of Affective Disorders, patients with a prior suicide attempt had poorer clinical outcomes and were more likely to later receive a diagnosis of bipolar disorder or substance use disorder.

Researchers performed a medical file audit to capture the clinical and functional features of patients receiving care from a mental health service in Australia (n=1143). Patients had a median age of 18.76 years (range, 12-30 years) and a median follow-up period of 21 months (range, 3-127 months). The most common diagnoses were depression (46%) and anxiety disorders (20%), and 75% of patients had comorbid conditions. Of the total participants, 57% were women.

Of the total cohort, 14% (n=164) had a prior suicide attempt. During the course of care, 2% of patients had recurrent suicide attempts and 6% had “new onset” of a suicide attempt. Prior suicide attempts predicted an increased likelihood for self-injurious behavior (odds ratio [OR], 1.71; 95% CI, 1.13-2.58), suicide ideation (OR, 1.72; 95% CI, 1.14-2.60), and recurrent suicide attempts (OR, 2.59; 95% CI, 1.52-4.41). In addition, those with a prior suicide attempt were more likely to later receive a diagnosis for bipolar disorder (OR, 2.99; 95% CI, 1.78-5.00), to develop a substance use disorder (OR, 2.87; 95% CI, 1.54-5.37), or to have psychosis-like experiences (OR, 1.78; 95% CI, 1.12-2.82). “New-onset” suicide attempts were associated with a history of suicidal ideation (P =.03) and self-harm (P =.02). Those with new-onset suicide attempts were also more likely to be women (P =.007). Recurring suicide attempts were associated with older age (P =.03) and the presence of an alcohol or substance use disorder (P =.03).

These data highlight the necessity of more targeted interventions for patients with a history of high-risk behavior, such as self-harm or suicide ideation. Additional resources should be allocated to assist patients with substance use disorders to mitigate the risk for suicide attempts.

Reference

Iorfino F, Hermens DF, Cross SPM, et al. Prior suicide attempts predict worse clinical and functional outcomes in young people attending a mental health service. J Affect Disord. 2018;238:563-569.