2026 ECNP Congress

PS02-2149

Differentiating adolescents with suicide attempts from those with suicidal ideation in an emergency neuropsychiatric setting

Claudia Scipioni — D. Marin, Y. Beorchia, M. Driutti, M. Longo, G. Fanelli, L. Castriotta, M. Colizzi · Unit of Psychiatry, Department of Medicine- University of Udine, Udine, Italy

2026 ECNP Congress

Background

Adolescent suicidal ideation and suicide attempts are clinically overlapping but may reflect partly distinct developmental pathways. Identifying markers associated with the transition from suicidal thoughts to suicidal behaviour [1] is important for risk formulation in acute child and adolescent neuropsychiatric settings. This study examined whether diagnostic, trait-based, and motivational dimensions differentiate adolescents with suicide attempts from those with suicidal ideation.

Methods

We conducted an observational study at the paediatric emergency department of Udine, Italy, between 1 September 2021 and 30 July 2023. Adolescents aged 12–18 years presenting with an index suicidal crisis were assessed after clinical stabilisation and within 3 days of emergency admission or discharge. Participants were classified in the group with suicide attempt when the index presentation included a self-injurious act with at least some intent to die, according to clinical assessment and Columbia-Suicide Severity Rating Scale (C-SSRS) definitions [2]; participants in the group with suicidal ideation only reported suicidal thoughts without an attempt. Baseline assessment included psychiatric history, the Schedule for Affective Disorders and Schizophrenia for School-Age Children – Present and Lifetime Version (K-SADS-PL), the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II), the Personality Inventory for DSM-5 (PID-5), the Motivational Interview for Suicidality in Adolescence (MIS-A), and C-SSRS indices. Follow-up assessments were scheduled at ~2 and 6 months. Group differences were examined using chi-square/Fisher tests, t-tests or Mann–Whitney tests, linear mixed-effects models, and multivariable logistic regression.

Results

The final sample included 92 adolescents: 47 in the group with a suicide attempt (51.1%) and 45 in the group with suicidal ideation only (48.9%). Median age was 15 years (interquartile range 14–16); 76 participants (82.6%) were female. At baseline, suicide attempters more frequently had a history of pharmacological treatment (61.7% vs 40.0%; p=0.037) and previous psychiatric hospital admission (70.2% vs 26.7%; p<0.001). Personality disorder-related symptoms were more frequent in the suicide attempt group (p<0.01), although SCID-II findings require caution in minors. Linear mixed-effects models showed higher PID-5 negative affectivity in the suicide attempt group at baseline (estimated marginal mean difference=0.25 [95% CI 0.04, 0.46]; p=0.02) and higher disinhibition (difference=0.29 [0.09, 0.49]; p=0.01) [3], with disinhibition differences persisting at follow-up. Attention-deficit/hyperactivity disorder (ADHD) was more common in the group with a suicide attempt (11/47 vs. 2/45), where MIS-A impulsivity was higher at baseline (68.1% vs 22.2%; p<0.01) [4], [5]. Conversely, perceived burdensomeness and pessimism were more prevalent in the group with suicidal ideation only. C-SSRS ideation severity and intensity did not differ significantly between groups, but both decreased from baseline to 6 months. In adjusted logistic regression, ADHD was associated with higher odds of belonging to the suicide attempt group, with wide confidence intervals reflecting sparse ADHD cases (adjusted OR=22.73 [1.38, 375.03]).

Conclusions

In adolescents presenting with suicidal crises, suicide attempts were differentiated less by ideation severity than by behavioural dyscontrol-related markers, including ADHD, impulsivity, and disinhibition. These findings support ideation-to-action models and suggest that acute risk assessment should integrate dimensional personality, motivational, and impulse-control markers alongside diagnostic evaluation.

References

  1. Klonsky, E. D., May, A. M., & Saffer, B. Y. (2016). Suicide, Suicide Attempts, and Suicidal Ideation. Annual review of clinical psychology, 12, 307–330.
  2. Posner, K., Brown, G. K., Stanley, B., Brent, D. A., Yershova, K. V., Oquendo, M. A., Currier, G. W., Melvin, G. A., Greenhill, L., Shen, S., & Mann, J. J. (2011). The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. The American journal of psychiatry, 168(12), 1266–1277.
  3. Krueger, R. F., Derringer, J., Markon, K. E., Watson, D., & Skodol, A. E. (2012). Initial construction of a maladaptive personality trait model and inventory for DSM-5. Psychological medicine, 42(9), 1879–1890.
  4. Auerbach, R. P., Stewart, J. G., & Johnson, S. L. (2017). Impulsivity and Suicidality in Adolescent Inpatients. Journal of abnormal child psychology, 45(1), 91–103.
  5. Balazs, J., & Kereszteny, A. (2017). Attention-deficit/hyperactivity disorder and suicide: A systematic review. World journal of psychiatry, 7(1), 44–59.