Abstract
BackgroundPsychiatric treatment of suicidal youths is often difficult and non-compliance in treatment is a significant problem. This prospective study compared characteristics and changes in cognitive functioning, self image and psychosocial functioning among 13 to 18 year-old adolescent psychiatric inpatients with suicide attempts (n = 16) and with no suicidality (n = 39)MethodsThe two-group pre-post test prospective study design included assessments by a psychiatrist, a psychologist and medical staff members as well as self-rated measures. DSM-III-R diagnoses were assigned using the SCID and thereafter transformed to DSM-IV diagnoses. Staff members assessed psychosocial functioning using the Global Assessment Scale (GAS). Cognitive performance was assessed using the Wechsler Adult Intelligence Scale, while the Offer Self-Image Questionnaire (OSIQ) was used to assess the subjects' self-image. ANCOVA with repeated measures was used to test changes from entry to discharge among the suicide attempters and non suicidal patients. Logistic regression modeling was used to assess variables associated with an improvement of 10 points or more in the GAS score.ResultsAmong suicide attempter patients, psychosocial functioning, cognitive performance and both the psychological self and body-image improved during treatment and their treatment compliance and outcome were as good as that of the non-suicidal patients. Suicidal ideation and hopelessness declined, and psychosocial functioning improved. Changes in verbal cognitive performance were more pronounced among the suicide attempters. Having an improved body-image associated with a higher probability of improvement in psychosocial functioning while higher GAS score at entry was associated with lower probability of functional improvement in both patient groups.ConclusionThese findings illustrate that a multimodal treatment program seems to improve psychosocial functioning and self-image among severely disordered suicidal adolescent inpatients. There were no changes in familial relationships, possibly indicating a need for more intensive family interventions when treating suicidal youths. Multimodal inpatient treatment including an individual therapeutic relationship seems recommendable for severely impaired psychiatric inpatients tailored to the suicidal adolescent's needs.
Highlights
Psychiatric treatment of suicidal youths is often difficult and non-compliance in treatment is a significant problem
Suicidal behavior is common among adolescent inpatients
Having an improved body-image associated significantly with a higher probability of improvement in psychosocial functioning while higher Global Assessment Scale (GAS) score at entry was associated with lower probability of functional improvement
Summary
Psychiatric treatment of suicidal youths is often difficult and non-compliance in treatment is a significant problem. Adolescents with previous suicide attempts and those with repeated attempts more commonly have affective and substance use disorders than non-suicidal youths and display externalizing behaviors and psychic distress as well as depressive symptoms and anger [9,12,13,14]. They often have a long-term history of suicidal behavior associated with poor parent-child communication [6]. Referral to psychiatric inpatient treatment is recommended if an adolescent makes a suicide attempt with high lethality or if she/he has previously attempted suicide, has suicidal relatives or lacks family support [15]
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