title: Proximal psychiatric risk factors for suicidality in youth: the Great Smoky Mountains Study.
abstract: BACKGROUND
  Psychiatric disorder is a major risk factor for suicidality but has poor positive predictive value.
  
  
  OBJECTIVE
  To characterize proximal risks for suicidality associated with anxiety, depressive, disruptive behavior, and substance use disorders, and to test whether there are critical combinations of disorders that discriminate at-risk youth independent of severity of psychopathology.
  
  
  METHODS
  The Great Smoky Mountains Study, a representative sample of children and adolescents aged 9 to 16 years from the southeastern United States. Subjects and their parents were interviewed on multiple occasions from 1993 to 2000 about the subjects' recent psychiatric and suicidal history.
  
  
  METHODS
  An epidemiological sample of youth.
  
  
  METHODS
  The sample included 1420 individual subjects with 6676 records across 8 waves of data collection.
  
  
  METHODS
  Wanting to die, suicidal ideation, suicide plans, or suicide attempt during the past 3 months.
  
  
  RESULTS
  Eleven broad psychiatric profiles discriminated suicidal youth. Risk was greatest in association with current depression plus anxiety (specifically GAD [generalized anxiety disorder]) (odds ratio, 468.53) or depression plus a disruptive disorder (primarily ODD [oppositional-defiant disorder]) (odds ratio, 222.94). Unless comorbid, anxiety and substance use disorders were not proximally associated with suicidality. The severity of symptom-related impairment and, in some cases, total symptom load explained risk associated with all psychiatric profiles except depression plus anxiety, specifically GAD (adjusted odds ratio, 50.16). Severity of impairment and poverty defined by federal guidelines for families were both independent risk factors, irrespective of psychiatric profile. Suicidal youth without diagnosable disorders had subthreshold (mostly disruptive) disorders, disabling relationship difficulties, or psychiatric symptoms without associated impairment.
  
  
  CONCLUSIONS
  Severity of symptom-related impairment and total symptom load explained most of the risk for suicidality associated with current psychiatric disorders. Only depression plus GAD discriminated at-risk youth independent of severity of psychopathology.
authors.affiliation: Department of Human Genetics, Virginia Institute for Psychiatric and Behavioral Genetics, Medical College of Virginia Commonwealth University, Richmond, VA 23298-0003, USA. foley.debra@gmail.com
authors.forename: Debra L
authors.initials: DL
authors.lastname: Foley
authors.forename: David B
authors.initials: DB
authors.lastname: Goldston
authors.forename: E Jane
authors.initials: EJ
authors.lastname: Costello
authors.forename: Adrian
authors.initials: A
authors.lastname: Angold
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology; D000367:Age Factors; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D002648:Child; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D009657:North Carolina / Q000453:epidemiology; D015995:Prevalence; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D015144:Southeastern United States / Q000453:epidemiology; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*