title: Suicide attempts and nonsuicidal self-injury in the treatment of resistant depression in adolescents: findings from the TORDIA study.
abstract: OBJECTIVE
  To evaluate the clinical and prognostic significance of suicide attempts (SAs) and nonsuicidal self-injury (NSSI) in adolescents with treatment-resistant depression.
  
  
  METHODS
  Depressed adolescents who did not improve with an adequate SSRI trial (N = 334) were randomized to a medication switch (SSRI or venlafaxine), with or without cognitive-behavioral therapy. NSSI and SAs were assessed at baseline and throughout the 24-week treatment period.
  
  
  RESULTS
  Of the youths, 47.4% reported a history of self-injurious behavior at baseline: 23.9% NSSI alone, 14% NSSI+SAs, and 9.5% SAs alone. The 24-week incidence rates of SAs and NSSI were 7% and 11%, respectively; these rates were highest among youths with NSSI+SAs at baseline. NSSI history predicted both incident SAs (hazard ratio [HR]= 5.28, 95% confidence interval [CI] = 1.80-15.47, z = 3.04, p = .002) and incident NSSI (HR = 7.31, z = 4.19, 95% CI = 2.88-18.54, p < .001) through week 24, and was a stronger predictor of future attempts than a history of SAs (HR = 1.92, 95% CI = 0.81-4.52, z = 2.29, p = .13). In the most parsimonious model predicting time to incident SAs, baseline NSSI history and hopelessness were significant predictors, adjusting for treatment effects. Parallel analyses predicting time to incident NSSI through week 24 identified baseline NSSI history and physical and/or sexual abuse history as significant predictors.
  
  
  CONCLUSIONS
  NSSI is a common problem among youths with treatment-resistant depression and is a significant predictor of future SAs and NSSI, underscoring the critical need for strategies that target the prevention of both NSSI and suicidal behavior.
  
  
  BACKGROUND
  Treatment of SSRI-Resistant Depression in Adolescents (TORDIA). URL: http://www.clinicaltrials.gov. Unique Identifier: NCT00018902.
authors.affiliation: University of California Los Angeles (UCLA), Department of Psychiatry, Los Angeles, CA 90095-6968, USA. jasarnow@mednet.ucla.edu
authors.forename: Joan Rosenbaum
authors.initials: JR
authors.lastname: Asarnow
authors.forename: Giovanna
authors.initials: G
authors.lastname: Porta
authors.forename: Anthony
authors.initials: A
authors.lastname: Spirito
authors.forename: Graham
authors.initials: G
authors.lastname: Emslie
authors.forename: Greg
authors.initials: G
authors.lastname: Clarke
authors.forename: Karen Dineen
authors.initials: KD
authors.lastname: Wagner
authors.forename: Benedetto
authors.initials: B
authors.lastname: Vitiello
authors.forename: Martin
authors.initials: M
authors.lastname: Keller
authors.forename: Boris
authors.initials: B
authors.lastname: Birmaher
authors.forename: James
authors.initials: J
authors.lastname: McCracken
authors.forename: Taryn
authors.initials: T
authors.lastname: Mayes
authors.forename: Michele
authors.initials: M
authors.lastname: Berk
authors.forename: David A
authors.initials: DA
authors.lastname: Brent
mesh_terms: D000293:Adolescent; D000928:Antidepressive Agents / Q000008:administration & dosage*; D002648:Child; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003511:Cyclohexanols / Q000008:administration & dosage; D003866:Depressive Disorder / Q000188:drug therapy / Q000628:therapy*; D057915:Drug Substitution; D005260:Female; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D012652:Self Mutilation / Q000517:prevention & control*; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage; D000069470:Venlafaxine Hydrochloride; D000092864:Suicide Prevention
chemical_list: D000928:Antidepressive Agents; D003511:Cyclohexanols; D017367:Selective Serotonin Reuptake Inhibitors; D000069470:Venlafaxine Hydrochloride