title: Alcohol use and psychiatric comorbid disorders predict deliberate self-harm behaviour and other suicidality among depressed adolescent outpatients in 1-year follow-up.
abstract: BACKGROUND
  Suicidality, including deliberate self-harm behaviour (DSH), represents one of the most adverse and clinically serious consequences of depression. More detailed longitudinal research is needed in order to find clinical risk factors of DSH and other suicidal behaviour among depressed adolescent outpatients in order to identify those at greatest risk of life-threatening behaviour.
  
  
  OBJECTIVE
  This follow-up study investigated alcohol use, Axis I comorbid disorders, depressive and anxiety symptoms, and psychosocial functioning as risk factors of suicidal behaviour, including DSH, among depressed adolescent outpatients during a 1-year follow-up.
  
  
  METHODS
  Consecutive depressed adolescent outpatients (n = 189) aged 13-19 years were interviewed at baseline and at follow-up by using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children-Present and Lifetime (K-SADS-PL) for DSM-IV Axis I diagnoses and self-report questionnaires. Suicidal behaviour was assessed by K-SADS suicidality items.
  
  
  RESULTS
  During 1-year follow-up, one-quarter of all participants, and almost three-quarters of suicidal adolescents had DSH. Alcohol use and mood disorder with Axis I comorbidity at baseline predicted both DSH and other suicidal behaviour during follow-up. Mood disorder during follow-up predicted all forms of suicidal behaviour.
  
  
  CONCLUSIONS
  Detection and effective treatment of continuing mood disorder, comorbid disorders and alcohol use may significantly improve clinician's ability to identify adolescent outpatients at high risk of subsequent DSH and other suicidal behaviour. Treatment interventions should aim at full recovery of depression.
authors.affiliation: National Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Helsinki, and Department of Psychology, University of Tampere, Tampere, Finland. virpi.tuisku@thl.fi
authors.forename: Virpi
authors.initials: V
authors.lastname: Tuisku
authors.forename: Mirjami
authors.initials: M
authors.lastname: Pelkonen
authors.forename: Olli
authors.initials: O
authors.lastname: Kiviruusu
authors.forename: Linnea
authors.initials: L
authors.lastname: Karlsson
authors.forename: Mauri
authors.initials: M
authors.lastname: Marttunen
mesh_terms: D000293:Adolescent; D000428:Alcohol Drinking / Q000523:psychology*; D015897:Comorbidity; D003863:Depression; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology; D010045:Outpatients / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D012306:Risk; D012307:Risk Factors; D016728:Self-Injurious Behavior / Q000209:etiology / Q000523:psychology*; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D055815:Young Adult