The Treatment of Adolescent Suicide Attempters study (TASA): predictors of suicidal events in an open treatment trial

Abstract

Objective: To identify the predictors of suicidal events and attempts in adolescent suicide attempters with depression treated in an open treatment trial.

Method: Adolescents who had made a recent suicide attempt and had unipolar depression (n =124) were either randomized (n = 22) or given a choice (n = 102) among three conditions. Two participants withdrew before treatment assignment. The remaining 124 youths received a specialized psychotherapy for suicide attempting adolescents (n = 17), a medication algorithm (n = 14), or the combination (n = 93). The participants were followed up 6 months after intake with respect to rate, timing, and predictors of a suicidal event (attempt or acute suicidal ideation necessitating emergency referral).

Results: The morbid risks of suicidal events and attempts on 6-month follow-up were 0.19 and 0.12, respectively, with a median time to event of 44 days. Higher self-rated depression, suicidal ideation, family income, greater number of previous suicide attempts, lower maximum lethality of previous attempt, history of sexual abuse, and lower family cohesion predicted the occurrence, and earlier time to event, with similar findings for the outcome of attempts. A slower decline in suicidal ideation was associated with the occurrence of a suicidal event.

Conclusions: In this open trial, the 6-month morbid risks for suicidal events and for reattempts were lower than those in other comparable samples, suggesting that this intervention should be studied further. Important treatment targets include suicidal ideation, family cohesion, and sequelae of previous abuse. Because 40% of events occurred with 4 weeks of intake, an emphasis on safety planning and increased therapeutic contact early in treatment may be warranted.

Trial registration: ClinicalTrials.gov NCT00080158.

Conflict of interest statement

The other authors report no conflicts of interest.

Figures

Figure 1. Consort Chart

Premature terminator = Patient needed treatment in addition to or instead of TASA protocol treatments. TASA assessments continue. Treatment dropout = Patient refused to continue TASA treatments but continued assessments. Study dropout = Patient refused to continue TASA treatments and assessments. Phase I = First 12 weeks of treatment. Phase II = Second 12 weeks of treatment. Randomized Old protocol = Randomization among medical algorithm, medication algorithm and TASA CBT. New protocol = Participant could choose to be randomized, or select one of the three treatments. CBT = Cognitive Behavior Therapy TASA = Treatment of Adolescent Suicide Attempters

Figure 2. Time to Onset of Suicidal Events and Attempts in TASA

TASA = Treatment of Adolescent Suicide Attempters

Figure 3. Mean SSI by Suicidal Event Group

SSI = Scale of Suicide Ideation

Figure 4. Mean CGAS by Suicide Attempt Group

CGAS = Children’s Global Assessment Scale