Various forms of suicidality in clinically referred depressed children and adolescents: relations of temperament and emotion self-regulation and clinical features

Tamás Zsuzsanna
Various forms of suicidality in clinically referred depressed children and adolescents: relations of temperament and emotion self-regulation and clinical features.
[Thesis] (Unpublished)

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Abstract in foreign language

Introduction: Although major depressive disorder (MDD) is associated with suicidal behaviors, some depressed individuals are not suicidal and others evidence different forms of suicidality. We examined various forms of suicidality specified in DSM-IV and their relations with temperament and emotion regulation (ER) and their clinical characteristics in two large samples of children and adolescents with MDD. Hypothesis: 1. The presence of any form of suicidal behavior (compared to its absence) is associated with: (a) higher level of trait negative emotionality, (b) more extensive deployment of maladaptive ER responses to dysphoria, (c) less extensive use of adaptive ER responses to dysphoria. 2. (a) Negative emotionality and (b) maladaptive ER is increasingly likely as suicidal behavior becomes more severe. 3. Adaptive ER responses to dysphoria attenuate the impact of negative emotionality on severity of suicidal behavior. Furthermore, we aimed to examine other dimensions of temperament (activity, shyness, and sociability) in the context of exploratory analyses. 4. (a) All forms of suicidal behavior increase with age, (b) adolescent girls are more likely to have suicide ideations and attempts than boys. Compared with nonsuicidal peers, suicidal children and adolescents (c) are more severely depressed, (d) have different depressive symptom profile, (e) are more likely to have comorbid psychiatric disorders. Methods: We analysed Hypothesis 1., 2. and 3. in a clinical sample of 407 children (ages 7-14 years) with MDD, and Hypothesis 4. in an enlarged clinical sample of 553 children with MDD (ages 7–14 years). Children’s DSM-IV diagnoses were based on semi-structured interviews and best-estimate psychiatric consensus. Parents independently provided ratings of their children’s temperament, and children separately completed an inventory of emotion regulation. Results: Using multivariate models, we failed to confirm the hypothesized relations of negative trait emotionality and suicidality, but confirmed that high maladaptive and low adaptive ER response tendencies increase the odds of suicidal behaviors, above and beyond the risk posed by depressive illness severity. Unplanned interaction terms between temperament dimensions (other than negative emotionality) and ER suggested that at some high-extremes of temperament, ER has no impact on suicidality but in their absence, adaptive ER lowers the risk of suicidality. Concerning the clinical characteristics, approximately 68% of the sample had recurrent thoughts of death, 48% had suicidal ideation, 30% had suicide plan, and 12% had attempted suicide. Compared with nonsuicidal peers, suicidal children and adolescents were more severely depressed, had more depressive symptoms, and more likely had comorbid disorders. However, depressed children and adolescents with various forms of suicidality were very similar in clinical characteristics. Feelings of worthlessness, depressed mood, psychomotor agitation, and comorbid separation anxiety and conduct disorders were independent correlates of at least 1 form of suicidality. Only feelings of worthlessness was related to all 4 suicidal behaviors, after adjustment for other depressive symptoms, comorbid disorders, and demographics. Conclusion: Depressed non-suicidal and depressed suicidal children had comparable levels of negative emotionality. A depressed child characterized by many maladaptive regulatory responses to dysphoria is likely to be a child with definite suicidal behaviors (ideation, plans, or attempts). Conversely, a more extensive repertoire of adaptive regulatory responses to dysphoria signals a decreased likelihood of specific suicidal behavior. Youngsters who have attempted suicide have the least favorable distress-specific emotion regulatory profile as mirrored by their considerably higher Maladaptive and considerably lower Adaptive ER score. Clinical characteristics differ between nonsuicidal and suicidal children and adolescents but are very similar across various forms of suicidality. Feelings of worthlessness may play a central role in the development of suicidal behavior. Interventions toward the enlarging the repertoire of adaptive ER responses to dysphoria, and the decreasing the repertoire of maladaptive ER responses, and the enhancement of self-esteem and amelioration of underlying psychopathology may be crucial for the prevention of suicide attempts in depressed children and adolescents.

Item Type: Thesis (PhD)
Creators: Tamás Zsuzsanna
Hungarian title label: Az öngyilkossági viselkedés különböző formái a gyermekkori kezdetű depresszióban: a temperamentum és az érzelmi szabályozás vonatkozásai és klinikai jellemzők
Divisions: Doctoral School of Clinical Medicine
Discipline label: Medicine > Clinical Medicine
Defence date label: 2018. January 08.
Item ID: 4081
MTMT id: 3401461
Date Deposited: 2017. Oct. 02. 15:29
Last Modified: 2020. May. 28. 12:26
Depository no.: B 6341
Defence/Citable status: Defended.

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