Xianchen Liu, MD, PhD; Amy L. Gentzler, PhD; Ping Tepper, PhD; Enikö Kiss, MD; Viola Osváth Kothencnè, MS; Zsuzsanna Tamás, MD; Ágnes Vetró, MD, PhD; and Maria Kovacs, PhD
Objective: To examine various forms of
suicidality specified in DSM-IV and their clinical characteristics in a large sample of children
and adolescents with major depressive disorder (MDD).
Method: Subjects included 553 children
and adolescents (aged 7.0-14.9 years) recruited between April 2000 and December 2004 from
23 mental health facilities in Hungary. Subjects
received standardized clinical evaluations and
best-estimate consensus DSM-IV diagnoses of MDD. All subjects were in a current episode of MDD
at their assessment date.
Results: Approximately 68% of the
sample had recurrent thoughts of death, 48% had
suicidal ideation, 30% had suicide plan, and 12% had
attempted suicide. Compared with nonsuicidal peers, suicidal children and adolescents
were more severely depressed, had more depressive symptoms, and more likely had comorbid
disorders. However, depressed children and adolescents with various forms of suicidality were
very similar in clinical characteristics. Feelings
of worthlessness, depressed mood, psychomotor agitation, and comorbid separation anxiety
and conduct disorders were independent correlates
of at least 1 form of suicidality. Only feelings of
worthlessness was related to all 4 suicidal behaviors, after adjustment for other depressive
symptoms, comorbid disorders, and demographics.
Conclusion: Clinical characteristics
differ between nonsuicidal and suicidal children
and adolescents but are very similar across
various forms of suicidality. Feelings of
worthlessness may play a central role in the development
of suicidal behavior. Interventions toward the enhancement of self-esteem and amelioration
of underlying psychopathology may be crucial for the prevention of suicide attempts in
depressed children and adolescents.
J Clin Psychiatry 2006;67(9):1442-1450
© Copyright 2006 Physicians Postgraduate Press, Inc.