title: Suicide attempts in a longitudinal sample of adolescents followed through adulthood: Evidence of escalation.
abstract: OBJECTIVE
  This study was designed to examine escalation in repeat suicide attempts from adolescence through adulthood, as predicted by sensitization models (and reflected in increasing intent and lethality with repeat attempts, decreasing amount of time between attempts, and decreasing stress to trigger attempts).
  
  
  METHODS
  In a prospective study of 180 adolescents followed through adulthood after a psychiatric hospitalization, suicide attempts, and antecedent life events were repeatedly assessed (M = 12.6 assessments, SD = 5.1) over an average of 13 years 6 months (SD = 4 years 5 months). Multivariate logistic, multiple linear, and negative binomial regression models were used to examine patterns over time.
  
  
  RESULTS
  After age 17-18, the majority of suicide attempts were repeat attempts (i.e., made by individuals with prior suicidal behavior). Intent increased both with increasing age, and with number of prior attempts. Medical lethality increased as a function of age but not recurrent attempts. The time between successive suicide attempts decreased as a function of number of attempts. The amount of precipitating life stress was not related to attempts.
  
  
  CONCLUSIONS
  Adolescents and young adults show evidence of escalation of recurrent suicidal behavior, with increasing suicidal intent and decreasing time between successive attempts. However, evidence that sensitization processes account for this escalation was inconclusive. Effective prevention programs that reduce the likelihood of individuals attempting suicide for the first time (and entering this cycle of escalation), and relapse prevention interventions that interrupt the cycle of escalating suicidal behavior among individuals who already have made attempts are critically needed. (PsycINFO Database Record
authors.affiliation: Department of Psychiatry and Behavioral Sciences.
authors.forename: David B
authors.initials: DB
authors.lastname: Goldston
authors.affiliation: Center for Youth, Family, and Community Partnerships, University of North Carolina at Greensboro.
authors.forename: Stephanie S
authors.initials: SS
authors.lastname: Daniel
authors.affiliation: Department of Biostatistics and Bioinformatics, Duke University.
authors.forename: Alaattin
authors.initials: A
authors.lastname: Erkanli
authors.affiliation: Department of Psychiatry and Behavioral Sciences.
authors.forename: Nicole
authors.initials: N
authors.lastname: Heilbron
authors.affiliation: Jane Addams College of Social Work, University of Illinois.
authors.forename: Otima
authors.initials: O
authors.lastname: Doyle
authors.affiliation: Department of Psychiatry and Behavioral Sciences.
authors.forename: Bridget
authors.initials: B
authors.lastname: Weller
authors.affiliation: Department of Psychiatry and Behavioral Sciences.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Sapyta
authors.affiliation: Center for Youth, Family, and Community Partnerships, University of North Carolina at Greensboro.
authors.forename: Andrew
authors.initials: A
authors.lastname: Mayfield
authors.affiliation: Center for Youth, Family, and Community Partnerships, University of North Carolina at Greensboro.
authors.forename: Madelaine
authors.initials: M
authors.lastname: Faulkner
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D033182:Intention; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology*; D013406:Suicide, Attempted / Q000523:psychology*; D055815:Young Adult