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Youth at highest risk of attempting suicide are severely depressed and suffered a recent romantic breakup or assault

Although depression is linked to suicide attempts, most depressed youth do not attempt suicide. However, youth with severe depression and externalizing behaviors such as aggression, along with high levels of stress and key stressors such as romantic breakup, being assaulted, and recent arrest, are likely to have the highest risk of attempting suicide, according to a new study. Primary care doctors should ask depressed youth about these issues, suggest University of California at Los Angeles researchers.

Joan R. Asarnow, Ph.D., and colleagues examined suicide attempts among 451 ethnically diverse depressed youth aged 12 to 21 years in the largest study of adolescent depression in primary care to date. In the past 6 months, 12 percent of these youths had attempted suicide. Those who attempted suicide were significantly more likely to be female (91.1 vs. 77 percent) and to have more severe depression.

After controlling for depression severity, only externalizing behaviors remained a significant predictor of suicide attempts, increasing the risk by 58 percent. After controlling for depression severity and externalizing behaviors, none of the other psychopathology factors (substance use, anxiety, and symptoms of post-traumatic stress disorder) contributed to the prediction of suicide attempts, although youth reporting suicide attempts had elevated substance use and anxiety symptoms, including post-traumatic stress symptoms. Suffering a romantic breakup or physical assault nearly doubled or tripled, respectively, the risk of attempting suicide.

The relationship between stressful events and suicide attempts is not always accounted for by psychopathology, note the researchers. The study was supported in part by the Agency for Healthcare Research and Quality (HS09908).

See "Suicide attempts among depressed adolescents in primary care," by Samantha R. Fordwood, M.A., Dr. Asarnow, Diana P. Huizar, B.A., and Steven P. Reise, Ph.D., in the Journal of Clinical Child and Adolescent Psychology 36(3), pp. 392-204, 2007.

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