Psychological Medicine

Original Articles

Prospective predictors of adolescent suicidality: 6-month post-hospitalization follow-up

S. Yena1 c1, L. M. Weinstocka1, M. S. Andovera2, E. S. Sheetsa3, E. A. Selbya4 and A. Spiritoa1

a1 Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA

a2 Department of Psychology, Fordham University, Bronx, NY, USA

a3 Department of Psychology, Colby College, Waterville, ME, USA

a4 Department of Psychology, Rutgers University, New Brunswick, NJ, USA

Background The aim of this study was to examine prospective predictors of suicide events, defined as suicide attempts or emergency interventions to reduce suicide risk, in 119 adolescents admitted to an in-patient psychiatric unit for suicidal behaviors and followed naturalistically for 6 months.

Method Structured diagnostic interviews and self-report instruments were administered to adolescent participants and their parent(s) to assess demographic variables, history of suicidal behavior, psychiatric disorders, family environment and personality/temperament.

Results Baseline variables that significantly predicted time to a suicide event during follow-up were Black race, high suicidal ideation in the past month, post-traumatic stress disorder (PTSD), childhood sexual abuse (CSA), borderline personality disorder (BPD), low scores on positive affectivity, and high scores on aggression. In a multivariate Cox regression analysis, only Black race, CSA, positive affect intensity and high aggression scores remained significant.

Conclusions Our findings suggest the following for adolescent populations: (1) in a very high-risk population, risk factors for future attempts may be more difficult to ascertain and some established risk factors (e.g. past suicide attempt) may not distinguish as well; and (2) cross-cutting constructs (e.g. affective and behavioral dysregulation) that underlie multiple psychiatric disorders may be stronger predictors of recurrent suicide events than psychiatric diagnoses. Our finding with respect to positive affect intensity is novel and may have practical implications for the assessment and treatment of adolescent suicide attempters.

(Received April 23 2012)

(Revised July 13 2012)

(Accepted July 16 2012)

(Online publication August 30 2012)

Key words

  • Adolescent;
  • aggression;
  • impulsivity;
  • positive affectivity;
  • suicide


c1 Address for correspondence: S. Yen, Ph.D., 700 Butler Drive, Providence, RI 02906, USA. (Email: