title: Predicting suicide attempts in depressed adolescents: Clarifying the role of disinhibition and childhood sexual abuse.
abstract: BACKGROUND
  Suicide is the second leading cause of death among adolescents, and depressed youth are six times more likely to make suicide attempts as compared to non-depressed adolescents. The present study examined the unique and interactive effects of two well-established correlates of suicidality - childhood sexual abuse (CSA) and disinhibition - in predicting suicide attempts among depressed adolescents.
  
  
  METHODS
  Participants were 163 adolescents (125 females) aged 13-18 (M=15.60, SD=1.27) diagnosed with Major Depressive Disorder (n=95, 58.3%) and/or Dysthymia (n=69, 42.3%) recruited from an acute residential treatment service. Participants completed interviews assessing psychopathology and suicidality, self-report measures of depressive symptoms and CSA, and a computerized disinhibition task.
  
  
  RESULTS
  Consistent with hypotheses, CSA moderated the association between disinhibition and adolescents' report of their past year and lifetime suicide attempts. Specifically, higher disinhibition was associated with a greater likelihood of having made a suicide attempt among adolescents with a history of CSA, but not among those without. The same pattern of results held in analyses of suicide attempt frequency.
  
  
  CONCLUSIONS
  Primary findings were based on observational, cross-sectional data, and therefore, causal relationships cannot be inferred. The gender imbalance in the sample precluded stratifying our analyses by gender. CSA was ascertained by self-report; replication of the results with more objective measures is warranted.
  
  
  CONCLUSIONS
  Our findings indicate that CSA and disinhibition may work together to predict elevated suicide risk, and these results have implications for early identification efforts in youth at high risk for suicide.
authors: Department of Psychiatry, Harvard Medical School; McLean Hospital, Center for Depression, Anxiety and Stress Research, Belmont, MA, USA. Electronic address: jstewart@mclean.harvard.edu.
authors: Jeremy G
authors: JG
authors: Stewart
authors: Department of Psychiatry, Harvard Medical School; McLean Hospital, Center for Depression, Anxiety and Stress Research, Belmont, MA, USA.
authors: Judy C
authors: JC
authors: Kim
authors: Department of Psychiatry, Harvard Medical School; McLean Hospital, Center for Depression, Anxiety and Stress Research, Belmont, MA, USA.
authors: Erika C
authors: EC
authors: Esposito
authors: Department of Psychiatry, Harvard Medical School; McLean Hospital, Center for Depression, Anxiety and Stress Research, Belmont, MA, USA.
authors: Joseph
authors: J
authors: Gold
authors: Harvard University, Department of Psychology, Cambridge, MA, USA.
authors: Matthew K
authors: MK
authors: Nock
authors: Department of Psychiatry, Harvard Medical School; McLean Hospital, Center for Depression, Anxiety and Stress Research, Belmont, MA, USA.
authors: Randy P
authors: RP
authors: Auerbach
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D002650:Child Abuse, Sexual / Q000523:psychology*; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000150:complications / Q000523:psychology*; D005260:Female; D006801:Humans; D007266:Inhibition, Psychological; D008297:Male; D013406:Suicide, Attempted / Q000517:prevention & control* / Q000523:psychology*
keywords: Adolescence; Child sexual abuse; Depression; Impulsivity; Suicide