Factors influencing treatment compliance among adolescents after suicide attempts and the relationship to later suicidal ideation.

摘要

This prospective study examined treatment in the aftermath of a medically significant suicide attempt, the rates of compliance with multiple forms of treatment, parental and individual factors that may influence treatment compliance, and the associations of treatment compliance with later suicidal symptoms. Participants included 85 adolescents psychiatrically hospitalized after a medically significant suicide attempt, and their primary caretakers. Interviews were conducted soon after the adolescents' suicide attempt and at 6, 12, 18, and 24 months post-hospitalization. Variables assessed included multiple treatment descriptors (e.g., types and frequencies of services received, rates of compliance), adolescent and parental factors which may influence treatment compliance (e.g., adolescent psychopathology, adolescent and parent ratings of the helpfulness of treatments, parental involvement in treatment, psychopathology, and expressions of anger and hostility), and measures of later suicidality (e.g., suicide ideation and re-attempts).; Individual psychotherapy, pharmacotherapy, and family psychotherapy were the most common forms of treatment received at each time point. Baseline adolescent externalizing diagnoses were predictive of increased risk of non-compliance with the psychosocial treatments (individual and family psychotherapy), while internalizing diagnoses were predictive of increased risk of pharmacotherapy non-compliance. Paternal conduct disorder symptoms were predictive of increased risk of non-compliance with individual or family therapy. Maternal depression symptoms were predictive of increased risk of non-compliance with family therapy, and of overall psychosocial treatment non-compliance. Paternal mania symptoms were predictive of decreased risk of non-compliance with individual psychotherapy. Parental evaluation of their children's individual therapy as helpful was predictive of lower risk of non-compliance with individual therapy. There were only limited associations between treatment compliance and later suicidal ideation. Pharmacotherapy compliance was associated with lower suicidal ideation at 18 and 24-month follow-ups, while individual therapy compliance was positively associated with suicidal ideation at 12 and 18-month follow-ups.; Generally, the results supported the notion that both adolescent and parental psychopathologies have effects on the compliance with treatment in the aftermath of a serious suicide attempt. Additionally, results show that parental involvement with, and positive evaluation of, therapy tend to predict better rates of compliance. The data have implications for clinical interventions with suicidal adolescents and their parents.