By Betsy Bates
Clincial Psychiatry News (Los Angeles Bureau) - October 2003 · Volume 31 · Number 10
WAIKOLOA, HAWAII — The 5% of adolescents who report attempting suicide more than once in the course of a year have a health risk profile "staggeringly" different from those who report trying to harm themselves once or not at all, according to a survey of thousands of New Hampshire high school students.
"Single [suicide] attempters appear to be signaling considerable pain and despair and may be at risk for future self-destructive behaviors," noted Harriet J. Rosenberg and Stanley D. Rosenberg, Ph.D., of Dartmouth Medical School in a poster presented at a meeting sponsored by the International College of Psychosomatic Medicine.
But despite saying they had tried to kill themselves, single suicide attempters showed no unique patterns of associated health risks, in stark contrast to teens who reported attempting suicide from 2 to 6 times.
This group was 13 times more likely than nonattempters to have symptoms of depression; 7 times more likely to have been sexually assaulted; and more than 6 times more likely to report weight problems. Multiple attempters were significantly more likely than other teens to be heavy users of drugs and alcohol. Boys in the group were more than 7 times more likely than others to report violent behavior, reported Dr. Rosenberg, professor of psychiatry.
"We found staggering differences between multiple attempters and other adolescents. They were at higher risk for every health risk we explored," said Ms. Rosenberg, instructor in psychiatry at the Lebanon, N.H., university, in an interview at the meeting.
"We really should just look for them."
Of particular clinical importance were health risks in multiple suicide attempters that did not seem directly related to suicidality, since these might be easier to detect in reticent teens, she added.
For example, the odds ratio for weight problems was 5 times greater among girls who repeatedly tried to harm themselves and nearly 7 times greater among boys who had made multiple suicide attempts. The powerful association between weight problems and multiple suicide attempts surprised the researchers and has not been previously reported.
"The 800-pound gorilla with suicidality is always depression, but these teens don't always come in and say they're depressed. They enter the dialogue [in] different ways," she said.
The Rosenbergs' study drew on findings from the 2001 New Hampshire Youth Risk Behavior Survey, which was administered to 16,664 teenagers in grades 9-12, in rural as well as urban public schools.
In all, 15% of students reported attempting suicide, with 10% of boys and 10% of girls saying they had tried to harm themselves once during the previous year. Multiple suicide attempts were reported by 4% of boys and 6% of girls.
Dr. Rosenberg noted that adolescents who reported a single suicide attempt demonstrated elevated risk over non-attempters in 10 health categories, especially depressed mood and sexual assault. However, one-time attempters were more similar to nonattempters than they were to multiple suicide attempters.
When the comparison was made between single and multiple suicide attempters, associated risk for depressed mood rose from 24% to 81%; sexual assault risk rose from 7% to 34%; physical assault risk rose from 11% to 33%; and risk for weight and body-image problems rose from 18% to 58%.
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