Alcohol use and psychiatric comorbid disorders predict deliberate self-harm behaviour and other suicidality among depressed adolescent outpatients in 1-year follow-up

Abstract

Background: Suicidality, including deliberate self-harm behaviour (DSH), represents one of the most adverse and clinically serious consequences of depression. More detailed longitudinal research is needed in order to find clinical risk factors of DSH and other suicidal behaviour among depressed adolescent outpatients in order to identify those at greatest risk of life-threatening behaviour. Aim: This follow-up study investigated alcohol use, Axis I comorbid disorders, depressive and anxiety symptoms, and psychosocial functioning as risk factors of suicidal behaviour, including DSH, among depressed adolescent outpatients during a 1-year follow-up. Methods: Consecutive depressed adolescent outpatients (n = 189) aged 13–19 years were interviewed at baseline and at follow-up by using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children—Present and Lifetime (K-SADS-PL) for DSM-IV Axis I diagnoses and self-report questionnaires. Suicidal behaviour was assessed by K-SADS suicidality items. Results: During 1-year follow-up, one-quarter of all participants, and almost three-quarters of suicidal adolescents had DSH. Alcohol use and mood disorder with Axis I comorbidity at baseline predicted both DSH and other suicidal behaviour during follow-up. Mood disorder during follow-up predicted all forms of suicidal behaviour. Conclusions: Detection and effective treatment of continuing mood disorder, comorbid disorders and alcohol use may significantly improve clinician's ability to identify adolescent outpatients at high risk of subsequent DSH and other suicidal behaviour. Treatment interventions should aim at full recovery of depression.

• Adolescence
• Alcohol use
• Deliberate self-harm behaviour
• DSM-IV mood disorders
• Longitudinal study

Acknowledgements

We thank research assistant Eevaliisa Orelma for her contribution to the patient recruitment and data management, and Hannele Heilä, M.D., Johanna Törrönen, M.D., and Kirsi Kettunen, M.D. for their contributions to the interview process. This study was financially supported by the Emil Aaltonen Foundation, the Yrjö Jahnsson Foundation and the Hospital District of the University of Helsinki.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.