A Prediction Risk Score for Suicidal Behavior from a 15-Year Prospective Study

• In Event: 1-040 - Family History of Suicidal Behaviors and Youth Outcomes

Integrative Statement

The prediction of suicidal behavior is one of the most challenging tasks for clinicians and researchers alike. In a meta-analysis of 50 years of research, the performance of identified predictors for suicidal ideation and behavior was only slightly better than chance, which is alarming for an outcome as life threatening as suicidal behavior. Extant studies are limited due to the lack of detailed longitudinal phenotypic characterization in order to identify symptoms that change over time and predict suicidal behavior. We report on results from a 15-year longitudinal study of 605 offspring of parents with mood disorders where we examined the trajectories of clinical risk factors of suicidal behavior specifically, depression symptoms, hopelessness, impulsivity, aggression, impulsive aggression, irritability, and whether they predict incident suicidal behavior above and beyond psychiatric disorders. We also compute a Prediction Risk Score (PRS) for suicidal behavior. The trajectory of depression symptomatology with the highest mean scores and variability over time was the only trajectory to predict suicidal behavior [OR=5.9, 95% CI (1.35, 25.8), p=0.02]. In addition, younger age [OR=0.80, 95% CI (0.72, 0.89), p<0.001], having a lifetime history of unipolar [OR=6.25, 95% CI (2.34, 16.7), p<0.001] and bipolar disorders [OR=4.98, 95% CI (1.26, 19.71), p=0.02], history of childhood abuse [OR=2.5, 95% CI (1.2, 5.2), p=0.01], and parental history of suicide attempt [OR=2.39, 95% CI (1.14, 5.02), p=0.02] were additional predictors. Endorsing ≥3 on our PRS resulted in 82.4% sensitivity and 67.3% specificity [Area Under the Curve=0.77]. The specificity and positive predictive value increased with the number of predictors endorsed. We identified 5 predictors for suicidal behavior that clinicians already assess or should be assessing during routine psychiatric evaluation, namely, the trajectory of depression symptoms with the highest mean scores and variability over time, younger age, mood disorder, parental history of suicidal behavior, and childhood history of abuse. Clinicians should monitor and treat mood symptoms to reduce their severity and fluctuation in high-risk patients to reduce their risk for suicidal behavior.

Author

• Nadine M Melhem, University of Pittsburgh School of Medicine
  Presenting Author