Suicide attempts and nonsuicidal self-injury in the treatment of resistant depression in adolescents

Findings from the TORDIA study

Joan Rosenbaum Asarnow, Giovanna Porta, Anthony Spirito, Graham Emslie, Greg Clarke, Karen Wagner, Benedetto Vitiello, Martin Keller, Boris Birmaher, James McCracken, Taryn Mayes, Michele Berk, David A. Brent

Research output: Contribution to journalArticle

224 Citations (Scopus)

Abstract

Objective: To evaluate the clinical and prognostic significance of suicide attempts (SAs) and nonsuicidal self-injury (NSSI) in adolescents with treatment-resistant depression. Method: Depressed adolescents who did not improve with an adequate SSRI trial (N = 334) were randomized to a medication switch (SSRI or venlafaxine), with or without cognitive-behavioral therapy. NSSI and SAs were assessed at baseline and throughout the 24-week treatment period. Results: Of the youths, 47.4% reported a history of self-injurious behavior at baseline: 23.9% NSSI alone, 14% NSSI+SAs, and 9.5% SAs alone. The 24-week incidence rates of SAs and NSSI were 7% and 11%, respectively; these rates were highest among youths with NSSI+SAs at baseline. NSSI history predicted both incident SAs (hazard ratio [HR]= 5.28, 95% confidence interval [CI] = 1.8015.47, z = 3.04, p =.002) and incident NSSI (HR = 7.31, z = 4.19, 95% CI = 2.8818.54, p <.001) through week 24, and was a stronger predictor of future attempts than a history of SAs (HR = 1.92, 95% CI = 0.814.52, z = 2.29, p =.13). In the most parsimonious model predicting time to incident SAs, baseline NSSI history and hopelessness were significant predictors, adjusting for treatment effects. Parallel analyses predicting time to incident NSSI through week 24 identified baseline NSSI history and physical and/or sexual abuse history as significant predictors. Conclusions: NSSI is a common problem among youths with treatment-resistant depression and is a significant predictor of future SAs and NSSI, underscoring the critical need for strategies that target the prevention of both NSSI and suicidal behavior.

Original languageEnglish (US)
Pages (from-to)772-781
Number of pages10
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Volume50
Issue number8
DOIs
StatePublished - Aug 2011

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Treatment-Resistant Depressive Disorder
Suicide
Wounds and Injuries
History
Confidence Intervals
Self-Injurious Behavior
Sex Offenses
Cognitive Therapy

Keywords

  • adolescents
  • depression
  • nonsuicidal self-injury
  • self-injurious behavior
  • suicide

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Developmental and Educational Psychology

Cite this

Suicide attempts and nonsuicidal self-injury in the treatment of resistant depression in adolescents : Findings from the TORDIA study. / Asarnow, Joan Rosenbaum; Porta, Giovanna; Spirito, Anthony; Emslie, Graham; Clarke, Greg; Wagner, Karen; Vitiello, Benedetto; Keller, Martin; Birmaher, Boris; McCracken, James; Mayes, Taryn; Berk, Michele; Brent, David A.

In: Journal of the American Academy of Child and Adolescent Psychiatry, Vol. 50, No. 8, 08.2011, p. 772-781.

Research output: Contribution to journalArticle

Asarnow, JR, Porta, G, Spirito, A, Emslie, G, Clarke, G, Wagner, K, Vitiello, B, Keller, M, Birmaher, B, McCracken, J, Mayes, T, Berk, M & Brent, DA 2011, 'Suicide attempts and nonsuicidal self-injury in the treatment of resistant depression in adolescents: Findings from the TORDIA study', Journal of the American Academy of Child and Adolescent Psychiatry, vol. 50, no. 8, pp. 772-781. https://doi.org/10.1016/j.jaac.2011.04.003
Asarnow, Joan Rosenbaum ; Porta, Giovanna ; Spirito, Anthony ; Emslie, Graham ; Clarke, Greg ; Wagner, Karen ; Vitiello, Benedetto ; Keller, Martin ; Birmaher, Boris ; McCracken, James ; Mayes, Taryn ; Berk, Michele ; Brent, David A. / Suicide attempts and nonsuicidal self-injury in the treatment of resistant depression in adolescents : Findings from the TORDIA study. In: Journal of the American Academy of Child and Adolescent Psychiatry. 2011 ; Vol. 50, No. 8. pp. 772-781.
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abstract = "Objective: To evaluate the clinical and prognostic significance of suicide attempts (SAs) and nonsuicidal self-injury (NSSI) in adolescents with treatment-resistant depression. Method: Depressed adolescents who did not improve with an adequate SSRI trial (N = 334) were randomized to a medication switch (SSRI or venlafaxine), with or without cognitive-behavioral therapy. NSSI and SAs were assessed at baseline and throughout the 24-week treatment period. Results: Of the youths, 47.4{\%} reported a history of self-injurious behavior at baseline: 23.9{\%} NSSI alone, 14{\%} NSSI+SAs, and 9.5{\%} SAs alone. The 24-week incidence rates of SAs and NSSI were 7{\%} and 11{\%}, respectively; these rates were highest among youths with NSSI+SAs at baseline. NSSI history predicted both incident SAs (hazard ratio [HR]= 5.28, 95{\%} confidence interval [CI] = 1.8015.47, z = 3.04, p =.002) and incident NSSI (HR = 7.31, z = 4.19, 95{\%} CI = 2.8818.54, p <.001) through week 24, and was a stronger predictor of future attempts than a history of SAs (HR = 1.92, 95{\%} CI = 0.814.52, z = 2.29, p =.13). In the most parsimonious model predicting time to incident SAs, baseline NSSI history and hopelessness were significant predictors, adjusting for treatment effects. Parallel analyses predicting time to incident NSSI through week 24 identified baseline NSSI history and physical and/or sexual abuse history as significant predictors. Conclusions: NSSI is a common problem among youths with treatment-resistant depression and is a significant predictor of future SAs and NSSI, underscoring the critical need for strategies that target the prevention of both NSSI and suicidal behavior.",
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AU - Spirito, Anthony

AU - Emslie, Graham

AU - Clarke, Greg

AU - Wagner, Karen

AU - Vitiello, Benedetto

AU - Keller, Martin

AU - Birmaher, Boris

AU - McCracken, James

AU - Mayes, Taryn

AU - Berk, Michele

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N2 - Objective: To evaluate the clinical and prognostic significance of suicide attempts (SAs) and nonsuicidal self-injury (NSSI) in adolescents with treatment-resistant depression. Method: Depressed adolescents who did not improve with an adequate SSRI trial (N = 334) were randomized to a medication switch (SSRI or venlafaxine), with or without cognitive-behavioral therapy. NSSI and SAs were assessed at baseline and throughout the 24-week treatment period. Results: Of the youths, 47.4% reported a history of self-injurious behavior at baseline: 23.9% NSSI alone, 14% NSSI+SAs, and 9.5% SAs alone. The 24-week incidence rates of SAs and NSSI were 7% and 11%, respectively; these rates were highest among youths with NSSI+SAs at baseline. NSSI history predicted both incident SAs (hazard ratio [HR]= 5.28, 95% confidence interval [CI] = 1.8015.47, z = 3.04, p =.002) and incident NSSI (HR = 7.31, z = 4.19, 95% CI = 2.8818.54, p <.001) through week 24, and was a stronger predictor of future attempts than a history of SAs (HR = 1.92, 95% CI = 0.814.52, z = 2.29, p =.13). In the most parsimonious model predicting time to incident SAs, baseline NSSI history and hopelessness were significant predictors, adjusting for treatment effects. Parallel analyses predicting time to incident NSSI through week 24 identified baseline NSSI history and physical and/or sexual abuse history as significant predictors. Conclusions: NSSI is a common problem among youths with treatment-resistant depression and is a significant predictor of future SAs and NSSI, underscoring the critical need for strategies that target the prevention of both NSSI and suicidal behavior.

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