Prediction of Adolescent Suicidal Events by Residual Depressive Symptoms After Intensive Treatment

Objective: Adolescents with a history of depression are at a high risk of recurrent suicidal ideation (SI) and attempts. To enhance risk prediction, we examined the association of individual residual symptoms of depression to suicidal events (suicide attempts, emergency room visits, and inpatient hospitalization) 6 months after discharge from treatment.

Methods: A retrospective post hoc analysis of patients aged 12-18 years examined depression symptoms at admission and discharge. Patients in an intensive treatment program (December 2013-September 2022) received psychosocial and medication management. The Quick Inventory of Depressive Symptomatology, Adolescent Version, assessed depressive symptoms at entry and discharge (n = 1,029), and suicidal events postdischarge were tracked (n = 736). Analysis of variance analyzed symptom severity changes, and logistic regression used residual symptoms and controls (age, sex, previous attempt, and nonsuicidal self-injury) to predict suicidal events.

Results: Sad mood, view of self, and SI improved the most, while mood and sleep disturbance were most prevalent at discharge. Sleep disturbance (odds ratio [OR] = 2.09, 95% CI, 1.24-3.53, P < .01) and SI (OR = 2.22, 95% CI, 1.26-3.90, P < .01) were the strongest predictors of hospitalization, and, together with anhedonia (OR = 1.40, 95% CI, 1.02-1.93, P < .05), they consistently predicted suicidal events during follow-up.

Conclusion: Residual sleep disturbance, SI, and anhedonia after treatment indicated risk post discharge and might inform continuity of care planning. These findings encourage further research about the relationships between specific residual symptoms and suicidal events.