Adult Psychiatric and Medical Outcomes of Early Adolescents Making Index Suicide Attempts Coming to Medical Attention

Background: While young people who attempt suicide are known to be at greater risk for future suicide attempts and death by suicide, less is known about other psychiatric and medical outcomes in adulthood. Longitudinal studies of children and adolescents making index attempts (IA) have focused on narrow outcomes, such as tabulating recurrence of suicidal behaviors, but few have examined other measures, including lifetime diagnoses, service use, and mortality outcomes, especially in early adolescents.

Methods: In this retrospective-prospective cohort study, we use the Rochester Epidemiology Project (REP) to identify a large cohort of early adolescents (n=164) who made IAs coming to medical attention between the ages of 10-14 years old during a 22-year period (01/01/1986 - 12/31/2007) in Olmsted County, MN. Medical record data is currently being used to collect follow-up information 15 to 35 years after the IA, depending on when the subject was enrolled. Outcomes include psychosocial characteristics (i.e., marital status, education, employment, housing), lifetime psychiatric and medical diagnoses, recurrent suicide attempts, and lifetime service use. Data on mortality has been gathered through the National Death Index. This study was approved by the Institutional Review Board at Mayo Clinic.

Results: Of 164 individuals ages 10-14 years old who made IAs coming to medical attention, 3 (1.8%) died on the index attempt, two by firearms and one by hanging. In the follow-up period, no subjects died by suicide and one died due to other causes. Other follow-up outcomes are in the process of being collected and will be completed by September 2023.

Discussion: This retrospective-prospective cohort study takes a lifetime perspective on suicide attempts coming to medical attention early in life. This is one of the first longitudinal studies to report on psychosocial, psychiatric, and medical outcomes in early adolescents, reporting follow-up data up to three decades after the IA. Prior research rarely examines adolescents under 15 years old and no studies follow adolescents for more than 15 years (Goldman-Mellor, 2014; Fergusson, 2005).

Conclusions/Implications: This study examines the potential prognostic significance of early adolescent IAs. It may shed light on whether IAs in early adolescence represent a temporary state of crisis or indicate early on a potential for long-term psychiatric disturbance. The results, which are currently being collected, could lend insight into whether individuals attempting suicide at a young age warrant clinical surveillance beyond the crisis period.

References:

Ayer L, Colpe L, Pearson M, Murphy E. Advancing Research in Child Suicide: A Call to Action. Journal of the American Academy of Child & Adolescent Psychiatry. 2020; 59: 1028-1035.

Goldman-Mellor SJ, Caspi A, Harrington H, et al. Suicide Attempt in Young People: A Signal for Long-term Health Care and Social Needs. JAMA Psychiatry. 2014; 71: 119–127.

Fergusson DM, Horwood LJ, Ridder EM, Beautrais AL. Suicidal behaviour in adolescence and subsequent mental health outcomes in young adulthood. Psychological Medicine. 2005; 35: 983–993.