Suicide Risk Assessment

Objective: Although a large number of risk markers for suicide ideation have been identified, little guidance has been provided to prospectively identify adolescents at risk for suicide ideation within community settings. The current study addressed this gap in the literature by utilizing classification tree analysis (CTA) to provide a decision-making model for screening adolescents at risk for suicide ideation. Method: Participants were N 4,799 youth (M age 16.15 years, SD 1.63) who completed both Waves 1 and 2 of the National Longitudinal Study of Adolescent to Adult Health. CTA was used to generate a series of decision rules for identifying adolescents at risk for reporting suicide ideation at Wave 2. Results: Findings revealed 3 distinct solutions with varying sensitivity and specificity for identifying adolescents who reported suicide ideation. Sensitivity of the classification trees ranged from 44.6% to 77.6%. The tree with greatest specificity and lowest sensitivity was based on a history of suicide ideation. The tree with moderate sensitivity and high specificity was based on depressive symptoms, suicide attempts or suicide among family and friends, and social support. The most sensitive but least specific tree utilized these factors and gender, ethnicity, hours of sleep, school-related factors, and future orientation. Conclusions: These classification trees offer community organizations options for instituting large-scale screenings for suicide ideation risk depending on the available resources and modality of services to be provided. This study provides a theoretically and empirically driven model for prospectively identifying adolescents at risk for suicide ideation and has implications for preventive interventions among at-risk youth. What is the public health significance of this article? This study provides a data-driven model for prospectively identifying adolescents at risk for suicide ideation. If replicated in future studies, this model could be used by organizations to provide options for instituting large-scale screenings for suicide ideation risk depending on the available resources and modality of services available.

Objetivos Caracterizar pacientes con intento suicida atendidos en Psiquiatría en la Unidad Primaria de Atención (UPA) La Estrella entre octubre-2004 y octubre-2005 y determinar la persistencia de ideación suicida, los factores asociados así como factores predictores. Métodos Caracterización inicial de pacientes con intento suicida (n=156). Diseño posterior de casos y controles (n=77) según persistencia de ideación suicida (n=27). Se determinaron los factores asociados y la predicción del riesgo suicida con un modelo multivariado. Resultados Los casos aumentaron de 6 en octubre-2004 hasta 10 en octubre-2005, con promedio mensual: 12 ± 3,6 casos. El 80 % tenía 30 años o menor edad, 66,7 % eran mujeres, 24,4 % estudiantes y 20,5 % desempleados. Como desencadenantes: disfunción familiar y conflictos de pareja en 35,2 % cada uno. El 49 % consumió alcohol previo al intento suicida. La persistencia de ideación suicida se asoció con tener 31 años o más, desempleo, más de un intento suicida previo, conflictos sin resolver y disfunción familiar. La no resolución de conflictos, OR=106,7 (IC 95 %: 6,8, 1668,4) y la disfunción familiar, OR=11,05 (IC95 %: 1,7, 71,2) fueron predictores de la persistencia de ideación suicida en el modelo de regresión logística. Conclusión La no resolución de conflictos y la disfunción familiar, predictores de la persistencia de ideación suicida en sujetos con intento suicida, el consumo de alcohol y otros factores asociados podrían controlarse con programas de prevención y promoción de salud mental.