Suicide Attempts and Nonsuicidal Self-Injury in the Treatment of Resistant Depression in Adolescents: Findings from the TORDIA Study

• Published in: Journal of the American Academy of Child and Adolescent Psychiatry Vol. 50; no. 8; pp. 772 - 781
• Main Authors: Asarnow, Joan Rosenbaum, Ph.D, Porta, Giovanna, M.S, Spirito, Anthony, Ph.D, Emslie, Graham, M.D, Clarke, Greg, Ph.D, Wagner, Karen Dineen, M.D., Ph.D, Vitiello, Benedetto, M.D, Keller, Martin, M.D, Birmaher, Boris, M.D, McCracken, James, M.D, Mayes, Taryn, M.S, Berk, Michele, Ph.D, Brent, David A., M.D
• Format: Journal Article
• Language: English
• Published: Maryland Heights, MO Elsevier Inc 01.08.2011; Elsevier; Elsevier BV
• Subjects: Adolescent; Adolescents; Adult and adolescent clinical studies; Antidepressive Agents - administration & dosage; At Risk Persons; Behavior Problems; Biological and medical sciences; Child; Child & adolescent psychiatry; Child Abuse; Child clinical studies; Cognitive Therapy; Combined Modality Therapy; Confidence intervals; Cyclohexanols - administration & dosage; Depression; Depression (Psychology); Depressive Disorder - drug therapy; Depressive Disorder - therapy; Drug Substitution; Drug Therapy; Female; Humans; Male; Medical sciences; Mental depression; Mood disorders; nonsuicidal self-injury; Outcomes of Treatment; Pediatrics; Predictor Variables; Proportional Hazards Models; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Self Destructive Behavior; Self Mutilation - prevention & control; self-injurious behavior; Selfinjury; Serotonin reuptake inhibitors; Serotonin Uptake Inhibitors - administration & dosage; Sexual Abuse; Suicidal behaviour; Suicide; Suicide - prevention & control; Suicides & suicide attempts; Venlafaxine Hydrochloride; nonsuicidal self-injury; depression; self-injurious behavior; adolescents; suicide; Human; Mood disorder; Self injury; Treatment resistance; Adolescent; Depression; Behavior; Suicide; Suicide attempt
• ISSN: 0890-8567; 1527-5418
• DOI: 10.1016/j.jaac.2011.04.003

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] = 1.80–15.47, z = 3.04, p = .002) and incident NSSI (HR = 7.31, z = 4.19, 95% CI = 2.88–18.54, p < .001) through week 24, and was a stronger predictor of future attempts than a history of SAs (HR = 1.92, 95% CI = 0.81–4.52, 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. Clinical Trial Registration Information—Treatment of SSRI-Resistant Depression in Adolescents (TORDIA). URL: http://www.clinicaltrials.gov . Unique Identifier: NCT00018902.