Differences in Psychiatric Diagnosis Between Non-Lethal and Highly Lethal Adolescent Suicide Attempters

Background and Purpose: The medical lethality of a suicidal act, defined as the seriousness of the physical consequences or risk to life, is the main determinant of the likelihood of death following a suicide attempt. Identifying characteristics of those at particular risk for highly lethal suicide attempts is important for informing clinical intervention strategies aimed to prevent suicide in adolescents, because individuals who make highly lethal suicide attempts have been found to exhibit a similar risk profile to suicide completers. Relatively little is known, however, about the characteristics differentiating between non-lethal and highly lethal suicide attempts in adolescents. The aim of this study was to determine if psychiatric diagnosis differed among adolescents who made non-lethal and highly lethal suicide attempts.

Methods: All psychiatric evaluations for adolescents who presented to an urban general hospital from 2006 to 2010 for a suicide attempt (N=375) were reviewed. The Lethality of Suicide Attempt Rating Scale II (LSARS-II) was used to measure medical lethality of suicide attempts, with LSARS-II scores of 0-1 representing non-lethal attempts, and scores of 5-10 representing highly lethal attempts. The sample of the current study consisted of 58 non-lethal and 20 highly lethal adolescent suicide attempters. Psychiatric diagnoses were derived from the psychiatric evaluation in the medical record, which were determined by licensed social workers, psychologists, or psychiatrists in accordance with DSM-IV-TR criteria.  Logistic regression was conducted to assess diagnostic differences between non-lethal and highly lethal suicide attempters, with gender and age covaried.

Results:  Depressive, disruptive, and anxiety disorders did not differentiate between non-lethal and highly lethal attempters in logistic regression analysis. However, substance abuse did differentiate between non-lethal and highly lethal attempters, with adolescents diagnosed with a substance abuse disorder being four and a half times more likely to have made a highly lethal attempt than those without the disorder (p = 0.04, OR = 4.57). Gender and age did not differentiate between non-lethal and highly lethal attempts.

Conclusions and Implications:  Substance abuse was the only psychiatric diagnosis to differentiate between non-lethal and highly lethal suicide attempts in adolescents, with neither gender nor age showing a significant relationship. These results suggest the importance of substance abuse as a risk factor for highly lethal suicide attempts in adolescence, over and above the role of male gender and older age. These findings suggest the need for routine suicide risk assessments for adolescents receiving substance abuse treatment, and for standard assessment for substance use with suicidal adolescents. Limitations included the lack of structured diagnostic interviews, the low prevalence of bipolar disorder in the sample precluding its inclusion in the analysis, and the study’s cross-sectional design. Future research should focus on the development of effective treatment strategies for adolescents with co-occurring suicidality and substance abuse, as they represent a population at risk for making highly lethal suicide attempts.