Violence encounters increase suicidal ideation among adolescents

Past-year violence increases suicidal ideation among adolescents with depression, according to a recent study.

Major depressive disorder was reported in 1 in 6 adolescents in 2019. Depression is the mental health disorder most linked to suicide, but suicidal ideation is normally not common among adolescents. Violence is a risk factor for increased rates of suicidal ideation, being linked to suicidal behaviors among adolescents.

It has been theorized that depression mediates the association between violence and suicide, but there is little data on this association in adolescents. However, recent adversity exposure has been linked to worse physical health, highlighting the need to determine the effects of negative encounters on suicidal behavior.

To determine the short-term effects of suicidal ideation among adolescents with depression and the association of recent violence encounters with suicidal ideation, investigators conducted a retrospective cohort study of adolescents diagnosed with depression from 2017 to 2018. Data was gathered from the IBM Explorys Electronic Health Record database.

Adolescents aged 10 to 19 years were included in the study cohort if they had a new ICD-10 CM diagnosis of depression, meaning they had no past-year documentation of depression or antidepressant prescriptions.

Cases of exposure were included if they occurred within 1 year prior to the index date. Types of violence reported included child maltreatment and physical assault. In cases where more than 1 act of violence was reported, the most recent experience was analyzed. Patients without exposure to violence in the prior year made up a control group.

The primary outcome of the study was suicidal ideation, which is considered a factor greatly associated with suicide attempts. A diagnosis of suicidal ideation withing 1 year of depression diagnosis was used to measure short-term suicidal risk.Covariates included race and ethnicity, sex, age group, and insurance type.

Among the 24,047 adolescents diagnosed with depression from 2017 to 2018, 1.6% reported a violence encounter in the prior year. Of the violence encounters reported, 42.6% were assault, 24.6% sexual abuse, 19% psychological abuse, 8.7% physical abuse, and 5% neglect or other violence.

Violence encounters were more often seen in participants who were younger, Black or Hispanic, and covered by public insurance. Previous substance use and mental illness were also more common in adolescents experiencing recent violence encounters.

Suicidal ideation was reported in 13.7% of adolescents within a year after being diagnosed with depression. Among those with recent violent encounters, 27.5% reported suicidal ideation, compared to 13.5% in the nonencounter group. Suicidal ideation was often documented at the time of depression diagnosis.

The risk of suicidal ideation was 1.7 times greater among adolescents with recent violent encounters. Recent sexual assault, abuse, or assault were the encounters most likely to lead to suicidal ideation.

Reference

Wang J, Harrer S, Zwald ML, et al. Association of recent violence encounters with suicidal ideation among adolescents with depression. JAMA Netw Open. 2023;6(3):e231190. doi:10.1001/jamanetworkopen.2023.1190