Deconstructing depression: specific symptoms predict future suicide attempts among clinical adolescents

Depression is a risk factor for suicide attempt, but its ability todifferentiate individuals at heightened risk as a total score falls short.Prospective investigations of individual depressive symptoms in relation toadolescent suicide attempt are limited and seldom control for established riskfactors such as attempt history and other depressive symptoms. Participants(n = 854) were suicidaladolescents enrolled in intensive outpatient treatment targeting suicidality.Depressive symptoms (composite measures of mood, sleep, appetite/weight, andpsychomotor disturbance, as well as single-item measures of disturbed concentration,negative self-appraisal, suicidal ideation (SI), anhedonia, and low energy) weremeasured at entry. Suicide attempts between treatment entry and six months afterdischarge were recorded (n = 156;‘future attempters’). Bivariate comparisons found significantdifferences between future attempters and non-attempters on all depressive symptomsbesides appetite/weight and psychomotor disturbances. Logistic regression showedthat only sleep disturbance and SI contributed to future attempt while controllingfor age, sex, attempt history, and other depressive symptoms. A subsequent modelrevealed that middle and late insomnia largely accounted for sleep’srelationship with future attempt. Age, attempt history, and SI were significantpredictors in both models. Difficulty with maintaining sleep, early morningawakenings, and severe SI might signal an additional warning for proximate suicideattempt, particularly in youth with attempt history. These results support themeasurement of deconstructed depressive symptoms as a practical addition to riskassessment for clinicians managing suicidal adolescents. Such specific riskindicators might signal the need for more intensive care and closer post-dischargemonitoring.