Prior suicide attempts predict worse clinical and functional outcomes in young people attending a mental health service

Frank Iorfino; Daniel F Hermens; Shane P M Cross; Natalia Zmicerevska; Alissa Nichles; Josine Groot; Adam J Guastella; Elizabeth M Scott; Ian B Hickie

doi:10.1016/j.jad.2018.06.032

Prior suicide attempts predict worse clinical and functional outcomes in young people attending a mental health service

J Affect Disord. 2018 Oct 1:238:563-569. doi: 10.1016/j.jad.2018.06.032. Epub 2018 Jun 14.

Authors

Frank Iorfino¹, Daniel F Hermens², Shane P M Cross³, Natalia Zmicerevska³, Alissa Nichles³, Josine Groot³, Adam J Guastella³, Elizabeth M Scott³, Ian B Hickie³

Affiliations

¹ Brain and Mind Centre, University of Sydney, 94 Mallet Street, Camperdown, Sydney, NSW, Australia. Electronic address: frank.iorfino@sydney.edu.au.
² Brain and Mind Centre, University of Sydney, 94 Mallet Street, Camperdown, Sydney, NSW, Australia; Sunshine Coast Mind and Neuroscience Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia.
³ Brain and Mind Centre, University of Sydney, 94 Mallet Street, Camperdown, Sydney, NSW, Australia.

PMID: 29940520
DOI: 10.1016/j.jad.2018.06.032

Abstract

Background: Mental disorders and suicidal thoughts and behaviours are common in help-seeking youth. Few studies report the longitudinal associations between these phenomena and clinical and functional outcomes. This study examined whether prior suicide attempts predict poorer outcomes in mental health service attendees.

Methods: Clinical and functional data from 1143 individuals (aged 12-30) attending a primary care-based mental health service in Australia were collected over 3-60 months (median = 21 months). Odds ratios (OR) with 95% confidence intervals for the effect of a prior suicide attempt on follow-up outcomes were estimated (adjusted for confounders).

Results: Prior suicide attempts were common (n = 164; 14%) and prospectively associated with suicidal thoughts (OR = 1.71), suicide attempts (OR = 2.59), self-harm (OR = 1.71), an increased likelihood of being diagnosed with bipolar disorder (OR = 2.99), and the onset of an alcohol/substance use disorder (OR = 2.87). Over the course of care, no suicide attempts were reported in 1052 (92%) individuals, but 25 (2%) had recurrent attempts, and 66 (6%) had new onset of an attempt. New onset was associated with being female and previous suicidal ideation or self-harm; recurrent attempts were associated with being older and comorbid alcohol/substance use disorder.

Limitations: The cohort includes only individuals who remained in clinical contact, and the consistency of their documentation varied (across clinicians and over time).

Conclusions: Young people with prior suicide attempts are vulnerable to ongoing suicidal behaviours, and poorer clinical and functional outcomes. More intensive management strategies may be needed to directly address these behaviours and the long-term risks they confer. These behaviours also emerge over the course of care among those with no previous history, which has important implications for active service-level strategies that target these behaviours for all of those who present to such services.

Keywords: Alcohol; Bipolar; Depression; Disability; Self-harm.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Australia
Child
Female
Humans
Male
Mental Disorders / epidemiology
Mental Disorders / psychology*
Mental Health Services / statistics & numerical data*
Odds Ratio
Primary Health Care / statistics & numerical data*
Prospective Studies
Suicidal Ideation
Suicide, Attempted / psychology*
Young Adult