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Suicidality, Psychopathology, and Gender in Incarcerated Adolescents in Austria

Belinda Plattner, M.D.; Steve S. L. The, M.D.; Helena C. Kraemer, Ph.D.; Ryan P. Williams, B.A.; Susanne M. Bauer, M.D.; Jochen Kindler, M.D.; Martha Feucht, M.D.; Max H. Friedrich, M.D.; and Hans Steiner, M.D.

Objective: Delinquent juveniles are at extreme risk for suicide with death rates 4 times higher than in the general population. Whereas psychopathologic risk factors for suicidal behavior in nonforensic adolescent populations are well defined, psychopathologies associated with suicidality in delinquent juveniles are not yet clear. The objective of this study was to determine gender-specific psychopathologic profiles associated with suicidality in detained juveniles.

Method: The Massachusetts Youth Screening Instrument-Second Version, the Youth Self-Report, and the Mini-International Neuropsychiatric Interview for children and adolescents were used to investigate juveniles in an Austrian pretrial detention facility. The study sample consisted of all juveniles entering the system between March 2003 and January 2005. Of the 370 eligible participants, 319 completed the study (53 girls and 266 boys; age range, 14 to 21 years; mean = 16.67, SD = 1.45 years).

Results: We found significantly higher prevalence rates of both current (p < .01) and lifetime (p < .001) suicidality in girls than in boys. Suicidal boys exhibited more psychopathology and a wider range of psychopathology compared to nonsuicidal boys. For suicidal girls, psychopathologies appeared more circumscribed (all relevant p values < .04). Using signal detection methods, major depressive disorder, attention-deficit/hyperactivity disorder, and social phobia identified boys at highest risk of suicidality, while a diagnosis of posttraumatic stress disorder identified girls at highest risk.

Conclusions: Suicidality levels are high in delinquent adolescents, especially in girls. Psychopathologic risk factors seem to be gender specific in this population. Not only depression, but also psychopathologies that usually do not arouse strong suspicion for an association with suicidal behavior, i.e., social phobia and ADHD in boys and PTSD in girls, might increase suicide risk. Further research in other countries is needed to replicate our results with respect to sociocultural influences.

(J Clin Psychiatry 2007;68:1593-1600)

Received March 2, 2007; accepted June 27, 2007. From the Departments of Child and Adolescent Neuropsychiatry (Drs. Plattner, Feucht, and Friedrich), General Psychiatry (Drs. Bauer and Kindler), and Pediatrics (Dr. Feucht), Medical University of Vienna, Vienna, Austria; the Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, Calif. (Drs. Plattner, Kraemer, and Steiner and Mr. Williams); and the Department of Psychiatry, Free University Medical Center, Amsterdam, The Netherlands (Dr. The).

Financial support for data collection and data management was received through a grant to Dr. Plattner from the Medical-Scientific Fund of the Mayor of the Federal Capital Vienna (grant 2236), Vienna, Austria. Data analysis, interpretation of the data, and preparation of the article were performed during a research fellowship of Dr. Plattner at the Stanford University School of Medicine. Funding for the research fellowship was provided through a stipend from the Austrian Ministry of Justice to Dr. Plattner (grant BMJ-G 306.341/003-III), Vienna, Austria.

This article represents original material and has not been presented previously in whole or in substantial part.

The authors thank Siegfried Kasper, M.D., Department of General Psychiatry, Medical University of Vienna, for his critical review of the manuscript. Dr. Kasper has no pertinent financial or other relationships to disclose.

None of the authors has any potential conflict of interest, including specific financial and commercial interests and conflicts relevant to the subject of the article.

Corresponding author and reprints: Martha Feucht, M.D., Universitätsklinik für Neuropsychiatrie des Kindes und Jugendalters, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090 Vienna, Austria (e-mail: