Category: Child / Adolescent - Depression

Symposium

Suicidal Behavior and Stress Generation in Adolescent Psychiatric Inpatients: A Contextual Threat Approach

Sunday, November 19
8:30 AM - 10:00 AM
Location: Sapphire 410, Level 4, Sapphire Level

Keywords: Suicide | Stress | Self-Injury
Presentation Type: Symposium

One of the most robust predictors of future suicide attempts (SAs) in the empirical literature is a past history of this behavior. Indeed, in one recent meta-analysis, a medium-to-large pooled effect was observed for this relationship across a median follow-up period of two years. A potential mechanism underlying the recurrence of SA is stress generation, the tendency for certain individuals to experience higher rates of dependent stress (i.e., stressors that are at least in part influenced by their own behaviors), but not to differ in rates of independent stress (i.e., stressors that occur outside the influence of the their behavior). This higher rate of dependent stress, particularly interpersonal dependent stress, was originally proposed to account for the high rate of recurrence of depression. Its applicability to SA has yet to be evaluated. Given the well documented role of life stress, particularly within interpersonal domains, in precipitating SAs, the possible relevance of stress generation to SA has potential to advance our understanding of the etiology of this behavior and inform treatment.

The current study evaluated the relevance of stress generation in a sample of 99 adolescent psychiatric inpatients followed for 6 months. Participants completed the Columbia-Suicide Severity Rating Scale, Suicidal Ideation Questionnaire Jr., and Children’s Depression Rating Scale-Revised at baseline, and the UCLA Life Stress Interview at follow-up. Consistent with the stress generation hypothesis, lifetime number of SAs prospectively predicted higher rates of dependent stress (b=.27, p<.05, d=.55, BF10=3.93), but not independent stress (b=.06, p=.33, d=.23, BF01=1.48), after sex, age, suicidal ideation and depression were covaried. This association was specific to interpersonal (b=.25, p<.05,d=.53, BF10=3.46), but not non-interpersonal (b=.02, p=.43, d=.18, BF01=1.65), dependent stress.


These results have implications for treatment. Unlike independent stress, dependent stress is modifiable, and thus it should be possible to reduce it occurrence. Adolescents with a history of suicidality may benefit from behavior modification strategies aimed at stress generation.

Richard Liu

Assistant Professor
Brown University

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