Risk of Suicide Attempt among Adolescents with Conduct Disorder: A Longitudinal Follow-up Study - 25/07/16

Doi : 10.1016/j.jpeds.2016.06.057

Han-Ting Wei, MD ^1,^5,^{*
Contributed equally.}, Wen-Hsuan Lan, MD ^1,^6,^{*
Contributed equally.}, Ju-Wei Hsu, MD ^1,², Ya-Mei Bai, MD, PhD ^1,², Kai-Lin Huang, MD ^1,², Tung-Ping Su, MD ^1,², Cheng-Ta Li, MD, PhD ^1,², Wei-Chen Lin, MD ^1,², Tzeng-Ji Chen, MD, PhD ^3,⁴, Mu-Hong Chen, MD ^1,^2,^*
¹ Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan
² Division of Psychiatry, Kunming Branch, Taipei City Hospital, Taipei, Taiwan
³ Division of Psychiatry, Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan
⁴ Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
⁵ Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
⁶ Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan

^*Reprint requests: Department of Psychiatry, Taipei Veterans General Hospital, No. 201, Shih-Pai Road, Sec. 2, 11217, Taipei, Taiwan.Department of PsychiatryTaipei Veterans General HospitalNo. 201, Shih-Pai Road, Sec. 2TaipeiTaiwan11217

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Abstract

Objective

To assess the independent or comorbid effect of conduct and mood disorders on the risk of suicide.

Study design

The Taiwan National Health Insurance Research Database was used to derive data for 3711 adolescents aged 12-17 years with conduct disorder and 14 844 age- and sex-matched controls between 2001 and 2009. The participants were followed up to the end of 2011, and those who attempted suicide during the follow-up period were identified.

Results

Adolescents with conduct disorder had a higher incidence of suicide (0.9% vs 0.1%; P < .001) and attempted suicide at a younger age (17.38 ± 2.04 vs 20.52 ± 1.70 years of age) than did the controls. The Cox proportional hazards regression model, after adjustment for demographic data and psychiatric comorbidities, determined that conduct disorder was an independent risk factor for subsequent suicide attempts (hazard ratio, 5.17; 95% CI, 2.29-11.70). The sensitivity after those with other psychiatric comorbidities were excluded revealed a consistent finding (hazard ratio, 10.32; 95% CI, 3.71-28.71).

Discussion

Adolescents with conduct disorder had an increased risk of suicide attempts over the next decade. Future studies are required to clarify the underlying pathophysiology and elucidate whether prompt intervention for conduct disorder could reduce this risk.

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Keywords : conduct disorder, suicide, psychiatric comorbidities

Abbreviations : ADHD, HR, ICD-9-CM, NHIRD