Suicide attempt characteristics, diagnoses, and future attempts: comparing multiple attempters to single attempters and ideators.
OBJECTIVE
To compare psychiatric diagnoses and future suicide attempt outcomes of multiple attempters (MAs), single attempters (SAs), and ideators.


METHODS
Two hundred twenty-eight teens who reported recent ideation or a lifetime suicide attempt in a screening of 1,729 high school students completed the Adolescent Suicide Interview, which provided information on attempt number and characteristics and mood, anxiety, and substance use disorder modules of the Diagnostic Interview Schedule for Children; 191 were reinterviewed 4 to 6 years later to ascertain interval attempts and psychiatric disorder. Between screening and follow-up, 33 (17%) teens made an attempt, 12 of whom were previously classified as lifetime MAs (more than one attempt) and six as SAs.


RESULTS
MAs more often met criteria for any one of the DSM diagnoses assessed at baseline (mood, anxiety, or substance use disorder; 71%), compared with SAs (39%) and ideators (41%), and at follow-up (mood, anxiety, substance use, or disruptive behavior disorder; 69%) compared with SAs (36%) (p <.05). As reported at baseline, MAs (versus SAs) more often wished to die during their attempt (53% versus 23%), less often planned their attempt for intervention (44% versus 76%), and more often regretted recovery (26% versus 7%; p <.05). Baseline MAs had significantly higher odds of making a later attempt compared to ideators (odds ratio 4.0, 95% confidence interval 1.5-10.2) and SAs (odds ratio 4.6, 95% confidence interval 1.0-20.2). No participants committed suicide during follow-up. SAs who made another attempt (versus those who did not) more often met criteria for a baseline anxiety disorder and more often wished to die during their baseline attempt.


CONCLUSIONS
MAs more strongly predict later suicidality and diagnosis than SAs and ideation. Forms that assess past suicide attempts should routinely inquire about frequency of attempts. The similarity between the present findings and those of clinical samples suggests that screening may yield a representative sample of suicide attempters and ideators.
Miranda
Regina
R
Dr. Miranda is with the Department of Psychology, Hunter College, City University of New York; Drs. Miranda, Scott, and Shaffer, and Mr. Hicks and Ms. Munfakh are with the Division of Child and Adolescent Psychiatry, Columbia University, College of Physicians and Surgeons; Dr. Wilcox is with the Johns Hopkins University School of Medicine. Electronic address: mirandar@childpsych.columbia.edu.
Scott
Michelle
M
Dr. Miranda is with the Department of Psychology, Hunter College, City University of New York; Drs. Miranda, Scott, and Shaffer, and Mr. Hicks and Ms. Munfakh are with the Division of Child and Adolescent Psychiatry, Columbia University, College of Physicians and Surgeons; Dr. Wilcox is with the Johns Hopkins University School of Medicine.
Hicks
Roger
R
Dr. Miranda is with the Department of Psychology, Hunter College, City University of New York; Drs. Miranda, Scott, and Shaffer, and Mr. Hicks and Ms. Munfakh are with the Division of Child and Adolescent Psychiatry, Columbia University, College of Physicians and Surgeons; Dr. Wilcox is with the Johns Hopkins University School of Medicine.
Wilcox
Holly C
HC
Dr. Miranda is with the Department of Psychology, Hunter College, City University of New York; Drs. Miranda, Scott, and Shaffer, and Mr. Hicks and Ms. Munfakh are with the Division of Child and Adolescent Psychiatry, Columbia University, College of Physicians and Surgeons; Dr. Wilcox is with the Johns Hopkins University School of Medicine.
Harris Munfakh
Jimmie Lou
JL
Dr. Miranda is with the Department of Psychology, Hunter College, City University of New York; Drs. Miranda, Scott, and Shaffer, and Mr. Hicks and Ms. Munfakh are with the Division of Child and Adolescent Psychiatry, Columbia University, College of Physicians and Surgeons; Dr. Wilcox is with the Johns Hopkins University School of Medicine.
Shaffer
David
D
Dr. Miranda is with the Department of Psychology, Hunter College, City University of New York; Drs. Miranda, Scott, and Shaffer, and Mr. Hicks and Ms. Munfakh are with the Division of Child and Adolescent Psychiatry, Columbia University, College of Physicians and Surgeons; Dr. Wilcox is with the Johns Hopkins University School of Medicine.
D000293:Adolescent; D001008:Anxiety Disorders / Q000453:epidemiology; D002648:Child; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000453:epidemiology*; D010552:Personality Assessment; D012008:Recurrence; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000453:epidemiology; D013406:Suicide, Attempted / Q000517:prevention & control / Q000706:statistics & numerical data*; D014481:United States