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Sequelae of Aggression in Acutely Suicidal Adolescents

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Abstract

The consequences of aggression on problem course and suicide risk were examined in 270 acutely suicidal adolescents (ages 12–17 years; 184 girls). Participants were assessed during psychiatric hospitalization (T1), 6-months post-hospitalization (T2), and 15 or more months post-hospitalization (T3). Study variables included self- and parent-reported aggression; self-reported internalizing symptoms, suicidal ideation, suicide attempt, and adverse events; and clinician-rated suicidal behavior. Aggression was not directly related to suicide attempt concurrently or prospectively. However, among more aggressive youth, internalizing symptoms were more predictive of T3 suicide attempt than among less aggressive youth. T1 aggression predicted aggressive incidents and the likelihood of incarceration prior to T3. Two-level hierarchical linear modeling indicated that self-reported aggression and internalizing problems were linked in terms of severity and rates of decline over time. Overall, parent-reported aggression was negatively associated with suicidal ideation. Findings highlight (a) the continuity and consequences of aggression, (b) a possible role of aggression in worsening suicide risk factors and potentiating suicide attempt, and (c) the importance of ongoing research on subtypes of suicidal adolescents.

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Notes

  1. The dates at which these dichotomous outcomes, including suicide attempt, occurred were unavailable, precluding use of, for example, survival analysis.

  2. Multinomial logistic regression was used to predict single or multiple suicide attempt history in contrast to a negative history of suicide attempt.

  3. To rule out that the effect of parent-reported aggression on SIQ-JR owed to simply having a different information source (parent vs. self-report), the model was rerun, controlling for parent-reported internalizing (CAFAS Moods/Emotions). Parent-reported aggression continued to predict SIQ-JR, B = −1.51, t(236) = −3.59, p = 0.001. Moreover, the effect of parent-reported internalizing on SIQ-JR intercepts was significant, B = 0.32, t(236) = 2.68, p = 0.008. Thus, both parental reports made unique contributions to SIQ-JR intercepts but in opposite directions.

  4. The effect grew stronger when more extreme groups were considered. Among youth showing aggression at 0.5 and 1 standard deviation above the mean, internalizing symptoms were correspondingly stronger predictors of suicide attempt, Exp (B) = 3.57 and 4.71, p < 0.01. The predictive strength of internalizing symptoms did not further diminish when considered in subsamples at .5 and 1 standard deviation below the mean on aggression.

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Acknowledgments

This research was generously supported by a Blue Cross/Blue Shield Foundation of Michigan grant and a Ronald McDonald House Foundation grant awarded to Cheryl A. King. Dr. Feingold was supported by NICHD grant 3R01HD046364-12S1. The authors are grateful for the substantial contributions of all evaluators, advisory team members, and research assistants. We also acknowledge Jean Pletcher for her administrative assistance. Preliminary findings were presented at the Annual Meeting of the American Academy of Child and Adolescent Psychiatry (2001).

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  1. Oregon Social Learning Center, Eugene, OR, USA

    David C. R. Kerr & Alan Feingold

  2. Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Jason J. Washburn

  3. Department of Psychiatry, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, USA

    Anne C. Kramer, Asha Z. Ivey & Cheryl A. King

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  1. David C. R. Kerr
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Correspondence to Cheryl A. King.

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Kerr, D.C.R., Washburn, J.J., Feingold, A. et al. Sequelae of Aggression in Acutely Suicidal Adolescents. J Abnorm Child Psychol 35, 817–830 (2007). https://doi.org/10.1007/s10802-007-9132-5

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