Suicidal behavior and associated factors in adolescents with depressive disorder

Objective: This study aimed to evaluate the relationship of suicidal behavior with the severity of depression, suicide probability, childhood traumatic experiences, emotional regulation difficulties, impulsivity, problem-solving skills, self-esteem, perceived social support and psychological resilience by comparing adolescent patients with a diagnosis of depressive disorder who had suicidal behavior with those with a diagnosis of depressive disorder without suicidal behavior and healthy controls. Method: The study was conducted at Manisa Celal Bayar University Faculty of Medicine Child and Adolescent Psychiatry Outpatient Clinic between November 2020 and March 2021. As a result of the interview, 39 adolescents aged 12-18 years who were diagnosed with depressive disorder and had suicidal behavior within the last month constituted the first case group, 40 adolescents aged 12-18 years who were diagnosed with depressive disorder and had no lifelong suicidal behavior constituted the second case group, and 39 healthy volunteer adolescents matched with these adolescents for age and sex constituted the healthy control group. All participants were administered K-SADS-PL-DSM-5 (Schedule for Affective Disorders and Schizophrenia for School-Age Children, Now and Lifetime Version-DSM-5), sociodemographic and clinical characteristics of the participants were recorded by evaluating the form prepared by researcher. Participants were asked to fill following items: DSM-5 level 2 depression scale child form, suicide probability scale, childhood traumatic experiences scale, difficulties in emotion regulation scale-short form, Barratt impulsivity scale, problem solving inventory, Rosenberg self-esteem scale, multidimensional perceived social support scale, child and adolescent psychological resilience scale. Results: In terms of sociodemographic and clinical features; it was determined that the depression group with suicidal behavior was evaluated as good at the lowest rate in terms of school success and friend relations, the healthy control group evaluated it as good at the highest rate, and the case groups had more history of psychiatric illness in themselves and in their families. It was determined that the depression group with suicidal behavior consumed more cigarettes and alcohol, had more self harming behaviour, had a higher rate of melancholic depression and disruptive behavioral disorders comorbidity. It was found that the depression group without suicidal behavior had a higher rate of physical illness and a higher rate of parental separation compared to healthy controls. While the depression group with suicidal behavior had the highest level of depression severity, suicide probability, childhood traumatic experiences, emotion regulation difficulties, and impulsivity; problem-solving skills, self-esteem, perceived social support and psychological resilience were lowest in this group. Suicidal attempt adolescents in depression group with suicidal behavior had higher comorbidity of disruptive behavior disorder, lower paternal education level, more difficulty in emotion regulation, and higher motor and total impulsivity levels compared to those who have suicidal ideation but did not attempt suicide. The evaluation of whole sample and case groups revealed that level 2 depression scale, childhood traumatic experiences scale, difficulties in emotion regulation scale-short form, Barratt impulsivity scale, problem solving inventory, Rosenberg self-esteem scale, multidimensional perceived social support scale, child and youth resilience scale were all correlated with suicide probability scale. Conclusions: It was determined that depression severity, suicide probability, childhood traumatic experiences, emotion regulation difficulties, impulsivity, problem solving skills, self-esteem, perceived social support and psychological resilience levels of depression group with suicidal behavior, depression group without suicidal behavior and healthy control group were significantly different. It was thought that the severity of depression, exposure to childhood traumatic experiences, emotional regulation difficulties, impulsivity, inadequate problem-solving skills, low self-esteem, lack of perceived social support and insufficient psychological resilience may increase the likelihood of suicide. There is a need for new studies on these variables at adolescent age group in order to determine the possibility of suicide and to prevent it.