The Treatment of Adolescent Suicide Attempters study (TASA): predictors of suicidal events in an open treatment trial.
OBJECTIVE
To identify the predictors of suicidal events and attempts in adolescent suicide attempters with depression treated in an open treatment trial.


METHODS
Adolescents who had made a recent suicide attempt and had unipolar depression (n =124) were either randomized (n = 22) or given a choice (n = 102) among three conditions. Two participants withdrew before treatment assignment. The remaining 124 youths received a specialized psychotherapy for suicide attempting adolescents (n = 17), a medication algorithm (n = 14), or the combination (n = 93). The participants were followed up 6 months after intake with respect to rate, timing, and predictors of a suicidal event (attempt or acute suicidal ideation necessitating emergency referral).


RESULTS
The morbid risks of suicidal events and attempts on 6-month follow-up were 0.19 and 0.12, respectively, with a median time to event of 44 days. Higher self-rated depression, suicidal ideation, family income, greater number of previous suicide attempts, lower maximum lethality of previous attempt, history of sexual abuse, and lower family cohesion predicted the occurrence, and earlier time to event, with similar findings for the outcome of attempts. A slower decline in suicidal ideation was associated with the occurrence of a suicidal event.


CONCLUSIONS
In this open trial, the 6-month morbid risks for suicidal events and for reattempts were lower than those in other comparable samples, suggesting that this intervention should be studied further. Important treatment targets include suicidal ideation, family cohesion, and sequelae of previous abuse. Because 40% of events occurred with 4 weeks of intake, an emphasis on safety planning and increased therapeutic contact early in treatment may be warranted.
Brent
David A
DA
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein and Ms. Zelazny are with the University of Pittsburgh, Western Psychiatric Institute & Clinic; Drs. Greenhill, Stanley, Posner, and Turner and Ms. Shen, Ms. Guggia, and Ms. Capasso are with the Columbia University-New York Psychiatric Institute; Drs. Emslie and Kennard and Ms. Hughes are with the University of Texas Southwestern Medical Center at Dallas; Drs. Wells, Compton, March, and Curry are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; and Drs. Walkup, Cwik, and Riddle and Ms. Barnett are with Johns Hopkins University. Electronic address: brentda@upmc.edu.
Greenhill
Laurence L
LL
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein and Ms. Zelazny are with the University of Pittsburgh, Western Psychiatric Institute & Clinic; Drs. Greenhill, Stanley, Posner, and Turner and Ms. Shen, Ms. Guggia, and Ms. Capasso are with the Columbia University-New York Psychiatric Institute; Drs. Emslie and Kennard and Ms. Hughes are with the University of Texas Southwestern Medical Center at Dallas; Drs. Wells, Compton, March, and Curry are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; and Drs. Walkup, Cwik, and Riddle and Ms. Barnett are with Johns Hopkins University.
Compton
Scott
S
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein and Ms. Zelazny are with the University of Pittsburgh, Western Psychiatric Institute & Clinic; Drs. Greenhill, Stanley, Posner, and Turner and Ms. Shen, Ms. Guggia, and Ms. Capasso are with the Columbia University-New York Psychiatric Institute; Drs. Emslie and Kennard and Ms. Hughes are with the University of Texas Southwestern Medical Center at Dallas; Drs. Wells, Compton, March, and Curry are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; and Drs. Walkup, Cwik, and Riddle and Ms. Barnett are with Johns Hopkins University.
Emslie
Graham
G
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein and Ms. Zelazny are with the University of Pittsburgh, Western Psychiatric Institute & Clinic; Drs. Greenhill, Stanley, Posner, and Turner and Ms. Shen, Ms. Guggia, and Ms. Capasso are with the Columbia University-New York Psychiatric Institute; Drs. Emslie and Kennard and Ms. Hughes are with the University of Texas Southwestern Medical Center at Dallas; Drs. Wells, Compton, March, and Curry are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; and Drs. Walkup, Cwik, and Riddle and Ms. Barnett are with Johns Hopkins University.
Wells
Karen
K
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein and Ms. Zelazny are with the University of Pittsburgh, Western Psychiatric Institute & Clinic; Drs. Greenhill, Stanley, Posner, and Turner and Ms. Shen, Ms. Guggia, and Ms. Capasso are with the Columbia University-New York Psychiatric Institute; Drs. Emslie and Kennard and Ms. Hughes are with the University of Texas Southwestern Medical Center at Dallas; Drs. Wells, Compton, March, and Curry are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; and Drs. Walkup, Cwik, and Riddle and Ms. Barnett are with Johns Hopkins University.
Walkup
John T
JT
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein and Ms. Zelazny are with the University of Pittsburgh, Western Psychiatric Institute & Clinic; Drs. Greenhill, Stanley, Posner, and Turner and Ms. Shen, Ms. Guggia, and Ms. Capasso are with the Columbia University-New York Psychiatric Institute; Drs. Emslie and Kennard and Ms. Hughes are with the University of Texas Southwestern Medical Center at Dallas; Drs. Wells, Compton, March, and Curry are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; and Drs. Walkup, Cwik, and Riddle and Ms. Barnett are with Johns Hopkins University.
Vitiello
Benedetto
B
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein and Ms. Zelazny are with the University of Pittsburgh, Western Psychiatric Institute & Clinic; Drs. Greenhill, Stanley, Posner, and Turner and Ms. Shen, Ms. Guggia, and Ms. Capasso are with the Columbia University-New York Psychiatric Institute; Drs. Emslie and Kennard and Ms. Hughes are with the University of Texas Southwestern Medical Center at Dallas; Drs. Wells, Compton, March, and Curry are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; and Drs. Walkup, Cwik, and Riddle and Ms. Barnett are with Johns Hopkins University.
Bukstein
Oscar
O
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein and Ms. Zelazny are with the University of Pittsburgh, Western Psychiatric Institute & Clinic; Drs. Greenhill, Stanley, Posner, and Turner and Ms. Shen, Ms. Guggia, and Ms. Capasso are with the Columbia University-New York Psychiatric Institute; Drs. Emslie and Kennard and Ms. Hughes are with the University of Texas Southwestern Medical Center at Dallas; Drs. Wells, Compton, March, and Curry are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; and Drs. Walkup, Cwik, and Riddle and Ms. Barnett are with Johns Hopkins University.
Stanley
Barbara
B
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein and Ms. Zelazny are with the University of Pittsburgh, Western Psychiatric Institute & Clinic; Drs. Greenhill, Stanley, Posner, and Turner and Ms. Shen, Ms. Guggia, and Ms. Capasso are with the Columbia University-New York Psychiatric Institute; Drs. Emslie and Kennard and Ms. Hughes are with the University of Texas Southwestern Medical Center at Dallas; Drs. Wells, Compton, March, and Curry are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; and Drs. Walkup, Cwik, and Riddle and Ms. Barnett are with Johns Hopkins University.
Posner
Kelly
K
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein and Ms. Zelazny are with the University of Pittsburgh, Western Psychiatric Institute & Clinic; Drs. Greenhill, Stanley, Posner, and Turner and Ms. Shen, Ms. Guggia, and Ms. Capasso are with the Columbia University-New York Psychiatric Institute; Drs. Emslie and Kennard and Ms. Hughes are with the University of Texas Southwestern Medical Center at Dallas; Drs. Wells, Compton, March, and Curry are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; and Drs. Walkup, Cwik, and Riddle and Ms. Barnett are with Johns Hopkins University.
Kennard
Betsy D
BD
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein and Ms. Zelazny are with the University of Pittsburgh, Western Psychiatric Institute & Clinic; Drs. Greenhill, Stanley, Posner, and Turner and Ms. Shen, Ms. Guggia, and Ms. Capasso are with the Columbia University-New York Psychiatric Institute; Drs. Emslie and Kennard and Ms. Hughes are with the University of Texas Southwestern Medical Center at Dallas; Drs. Wells, Compton, March, and Curry are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; and Drs. Walkup, Cwik, and Riddle and Ms. Barnett are with Johns Hopkins University.
Cwik
Mary F
MF
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein and Ms. Zelazny are with the University of Pittsburgh, Western Psychiatric Institute & Clinic; Drs. Greenhill, Stanley, Posner, and Turner and Ms. Shen, Ms. Guggia, and Ms. Capasso are with the Columbia University-New York Psychiatric Institute; Drs. Emslie and Kennard and Ms. Hughes are with the University of Texas Southwestern Medical Center at Dallas; Drs. Wells, Compton, March, and Curry are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; and Drs. Walkup, Cwik, and Riddle and Ms. Barnett are with Johns Hopkins University.
Wagner
Ann
A
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein and Ms. Zelazny are with the University of Pittsburgh, Western Psychiatric Institute & Clinic; Drs. Greenhill, Stanley, Posner, and Turner and Ms. Shen, Ms. Guggia, and Ms. Capasso are with the Columbia University-New York Psychiatric Institute; Drs. Emslie and Kennard and Ms. Hughes are with the University of Texas Southwestern Medical Center at Dallas; Drs. Wells, Compton, March, and Curry are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; and Drs. Walkup, Cwik, and Riddle and Ms. Barnett are with Johns Hopkins University.
Coffey
Barbara
B
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein and Ms. Zelazny are with the University of Pittsburgh, Western Psychiatric Institute & Clinic; Drs. Greenhill, Stanley, Posner, and Turner and Ms. Shen, Ms. Guggia, and Ms. Capasso are with the Columbia University-New York Psychiatric Institute; Drs. Emslie and Kennard and Ms. Hughes are with the University of Texas Southwestern Medical Center at Dallas; Drs. Wells, Compton, March, and Curry are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; and Drs. Walkup, Cwik, and Riddle and Ms. Barnett are with Johns Hopkins University.
March
John S
JS
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein and Ms. Zelazny are with the University of Pittsburgh, Western Psychiatric Institute & Clinic; Drs. Greenhill, Stanley, Posner, and Turner and Ms. Shen, Ms. Guggia, and Ms. Capasso are with the Columbia University-New York Psychiatric Institute; Drs. Emslie and Kennard and Ms. Hughes are with the University of Texas Southwestern Medical Center at Dallas; Drs. Wells, Compton, March, and Curry are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; and Drs. Walkup, Cwik, and Riddle and Ms. Barnett are with Johns Hopkins University.
Riddle
Mark
M
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein and Ms. Zelazny are with the University of Pittsburgh, Western Psychiatric Institute & Clinic; Drs. Greenhill, Stanley, Posner, and Turner and Ms. Shen, Ms. Guggia, and Ms. Capasso are with the Columbia University-New York Psychiatric Institute; Drs. Emslie and Kennard and Ms. Hughes are with the University of Texas Southwestern Medical Center at Dallas; Drs. Wells, Compton, March, and Curry are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; and Drs. Walkup, Cwik, and Riddle and Ms. Barnett are with Johns Hopkins University.
Goldstein
Tina
T
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein and Ms. Zelazny are with the University of Pittsburgh, Western Psychiatric Institute & Clinic; Drs. Greenhill, Stanley, Posner, and Turner and Ms. Shen, Ms. Guggia, and Ms. Capasso are with the Columbia University-New York Psychiatric Institute; Drs. Emslie and Kennard and Ms. Hughes are with the University of Texas Southwestern Medical Center at Dallas; Drs. Wells, Compton, March, and Curry are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; and Drs. Walkup, Cwik, and Riddle and Ms. Barnett are with Johns Hopkins University.
Curry
John
J
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein and Ms. Zelazny are with the University of Pittsburgh, Western Psychiatric Institute & Clinic; Drs. Greenhill, Stanley, Posner, and Turner and Ms. Shen, Ms. Guggia, and Ms. Capasso are with the Columbia University-New York Psychiatric Institute; Drs. Emslie and Kennard and Ms. Hughes are with the University of Texas Southwestern Medical Center at Dallas; Drs. Wells, Compton, March, and Curry are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; and Drs. Walkup, Cwik, and Riddle and Ms. Barnett are with Johns Hopkins University.
Barnett
Shannon
S
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein and Ms. Zelazny are with the University of Pittsburgh, Western Psychiatric Institute & Clinic; Drs. Greenhill, Stanley, Posner, and Turner and Ms. Shen, Ms. Guggia, and Ms. Capasso are with the Columbia University-New York Psychiatric Institute; Drs. Emslie and Kennard and Ms. Hughes are with the University of Texas Southwestern Medical Center at Dallas; Drs. Wells, Compton, March, and Curry are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; and Drs. Walkup, Cwik, and Riddle and Ms. Barnett are with Johns Hopkins University.
Capasso
Lisa
L
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein and Ms. Zelazny are with the University of Pittsburgh, Western Psychiatric Institute & Clinic; Drs. Greenhill, Stanley, Posner, and Turner and Ms. Shen, Ms. Guggia, and Ms. Capasso are with the Columbia University-New York Psychiatric Institute; Drs. Emslie and Kennard and Ms. Hughes are with the University of Texas Southwestern Medical Center at Dallas; Drs. Wells, Compton, March, and Curry are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; and Drs. Walkup, Cwik, and Riddle and Ms. Barnett are with Johns Hopkins University.
Zelazny
Jamie
J
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein and Ms. Zelazny are with the University of Pittsburgh, Western Psychiatric Institute & Clinic; Drs. Greenhill, Stanley, Posner, and Turner and Ms. Shen, Ms. Guggia, and Ms. Capasso are with the Columbia University-New York Psychiatric Institute; Drs. Emslie and Kennard and Ms. Hughes are with the University of Texas Southwestern Medical Center at Dallas; Drs. Wells, Compton, March, and Curry are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; and Drs. Walkup, Cwik, and Riddle and Ms. Barnett are with Johns Hopkins University.
Hughes
Jennifer
J
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein and Ms. Zelazny are with the University of Pittsburgh, Western Psychiatric Institute & Clinic; Drs. Greenhill, Stanley, Posner, and Turner and Ms. Shen, Ms. Guggia, and Ms. Capasso are with the Columbia University-New York Psychiatric Institute; Drs. Emslie and Kennard and Ms. Hughes are with the University of Texas Southwestern Medical Center at Dallas; Drs. Wells, Compton, March, and Curry are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; and Drs. Walkup, Cwik, and Riddle and Ms. Barnett are with Johns Hopkins University.
Shen
Sa
S
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein and Ms. Zelazny are with the University of Pittsburgh, Western Psychiatric Institute & Clinic; Drs. Greenhill, Stanley, Posner, and Turner and Ms. Shen, Ms. Guggia, and Ms. Capasso are with the Columbia University-New York Psychiatric Institute; Drs. Emslie and Kennard and Ms. Hughes are with the University of Texas Southwestern Medical Center at Dallas; Drs. Wells, Compton, March, and Curry are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; and Drs. Walkup, Cwik, and Riddle and Ms. Barnett are with Johns Hopkins University.
Gugga
S Sonia
SS
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein and Ms. Zelazny are with the University of Pittsburgh, Western Psychiatric Institute & Clinic; Drs. Greenhill, Stanley, Posner, and Turner and Ms. Shen, Ms. Guggia, and Ms. Capasso are with the Columbia University-New York Psychiatric Institute; Drs. Emslie and Kennard and Ms. Hughes are with the University of Texas Southwestern Medical Center at Dallas; Drs. Wells, Compton, March, and Curry are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; and Drs. Walkup, Cwik, and Riddle and Ms. Barnett are with Johns Hopkins University.
Turner
J Blake
JB
Drs. Vitiello and Wagner are with the National Institute of Mental Health; Drs. Brent, Bukstein, and Goldstein and Ms. Zelazny are with the University of Pittsburgh, Western Psychiatric Institute & Clinic; Drs. Greenhill, Stanley, Posner, and Turner and Ms. Shen, Ms. Guggia, and Ms. Capasso are with the Columbia University-New York Psychiatric Institute; Drs. Emslie and Kennard and Ms. Hughes are with the University of Texas Southwestern Medical Center at Dallas; Drs. Wells, Compton, March, and Curry are with the Duke University Medical Center; Dr. Coffey is with the New York University Child Study Center; and Drs. Walkup, Cwik, and Riddle and Ms. Barnett are with Johns Hopkins University.
D000293:Adolescent; D000465:Algorithms; D000928:Antidepressive Agents / Q000627:therapeutic use*; D002648:Child; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D019263:Dysthymic Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D010555:Personality Inventory; D055502:Secondary Prevention; D013406:Suicide, Attempted / Q000517:prevention & control* / Q000523:psychology* / Q000706:statistics & numerical data
D000928:Antidepressive Agents