A 16-year-old girl comes to the office for psychiatric follow-up accompanied by her mother. The patient has a history of depression and was started on fluoxetine 2 weeks ago. Her energy and appetite have improved, but she still struggles with feelings of sadness and low self-esteem. She has difficulty fitting in with social groups at school and tends to keep to herself. The patient's depression was diagnosed at age 14 after she attempted suicide by an overdose of 15 acetaminophen tablets. At that time, she was being sexually abused by a friend of the family; the abuse has since stopped. She also has a history of cutting behavior and self-induced vomiting. The patient uses marijuana and alcohol and has tried cocaine twice but did not like it. Family history is significant for depression in her mother and suicide in her father. The patient has had fleeting thoughts that she would be "better off dead" and "wonders how people would feel if I were gone," but she has had no suicidal intent or suicide plan. Which of the following is the strongest risk factor for suicide in this patient?

Question

A 16-year-old girl comes to the office for psychiatric follow-up accompanied by her mother.  The patient has a history of depression and was started on fluoxetine 2 weeks ago.  Her energy and appetite have improved, but she still struggles with feelings of sadness and low self-esteem.  She has difficulty fitting in with social groups at school and tends to keep to herself.  The patient's depression was diagnosed at age 14 after she attempted suicide by an overdose of 15 acetaminophen tablets.  At that time, she was being sexually abused by a friend of the family; the abuse has since stopped.  She also has a history of cutting behavior and self-induced vomiting.  The patient uses marijuana and alcohol and has tried cocaine twice but did not like it.  Family history is significant for depression in her mother and suicide in her father.  The patient has had fleeting thoughts that she would be "better off dead" and "wonders how people would feel if I were gone," but she has had no suicidal intent or suicide plan.  Which of the following is the strongest risk factor for suicide in this patient?

Quizplus · Accepted Answer

11ec25c8_d80c_d868_bc81_a3781ea382e8_MD0003_00 This patient has a number of predisposing factors that increase her risk for suicide, including a psychiatric disorder, previous suicide attempt, history of cutting (nonsuicidal self-injury) and sexual abuse, and family history of suicide. Additional factors include her social isolation and use of drugs and alcohol. The strongest single factor predictive of suicide, however, is her history of a prior suicide attempt (ie, acetaminophen overdose), as previous behavior predicts future behavior. Comprehensive suicide assessment includes evaluation of both risk and protective factors. Elderly persons (age >65), especially elderly white men, are at increased risk of suicide. The suicide rate for adolescents and young adults (age 15-24) also remains high, with impulsivity, hopelessness, substance use, and suicide contagion contributing largely to the rate. (Choices A, B, C, E, and G) Family history of suicide and personal history of cutting behavior, depression, sexual abuse, and social isolation are all lesser risk factors. (Choice F) Although a slightly increased risk of suicidality has been reported in adolescents treated with antidepressant medications compared with placebo, this patient's history of suicide attempt is a much stronger risk factor. (Choice H) The disinhibiting effects of alcohol and drugs frequently contribute to impulsively acting out on suicidal thoughts, especially among adolescents and young adults. Substance use is a significant risk factor for this patient, but not as strong a factor as her prior suicide attempt. Educational objective: The greatest risk factor for suicide is a history of suicide attempt(s). References: Suicide attempt as a risk factor for completed suicide: even more lethal than we knew. (http://www.ncbi.nlm.nih.gov/pubmed/27523496) Suicide and suicide attempts in adolescents. (http://www.ncbi.nlm.nih.gov/pubmed/27354459)

A 16-Year-Old Girl Comes to the Office for Psychiatric Follow-Up