Suicidal Behavior in Patients with Adjustment Disorders
Abstract
Summary: This retrospective study characterizes the suicidal behavior in 119 patients with Axis I adjustment disorders as assessed by psychiatrists at the University of Virginia Hospital. Results indicated that 72 patients (60.5%) had documented suicide attempts in the past, 96% had been suicidal during their admission to the hospital, and 50% had attempted suicide before their hospitalization. The most commonly used method of suicide attempts was overdosing. Of the sample group with suicide attempts in the past, 67% had Axis II diagnoses of borderline personality disorder and antisocial personality disorder. Adjustment disorder diagnosis in patients with the suicide attempts was associated with a high level of suicidality at admission, involuntary hospitalization and substance-abuse disorders. Axis II diagnoses in patients with adjustment disorders constituted risk factors for further suicidal behavior. Additional future prospective studies with reliability checks on diagnosis of adjustment disorders and suicidal behavior are needed.
References
(1997). Overdose among youth in Bahrain: Psychosocial characteristics, contact with helping agencies and problems. Journal of the Royal Society of Health, 117, 366–371
(1982). The predictive value of adjustment disorders: A follow-up study. American Journal of Psychiatry, 139, 584–590
(1980). Adjustment disorders in adolescents and adults. Archives of General Psychiatry, 37, 1166–1170
(1993). Suicidal behavior in adult psychiatric outpatients. I: Description and prevalence. American Journal of Psychiatry, 150, 108–112
(1997). Characteristics of borderline personality disorder associated with suicidal behavior. American Journal of Psychiatry, 154(12), 1715–1719
(1989). Validity of adjustment disorder, comparison with major depression. Journal of Affective Disorders, 17, 229–236
(1989). Personality disorder and suicide intent. Acta Psychiatrica Scandinavica, 79, 290–295
(1996). Suicidal behavior in patients with major depression and comorbid personality disorders. Journal of Affective Disorders, 39, 61–72
(1986). Adjustment disorders and suicidality. Psychological Reports, 59, (2, pt 1) 355–358
(1995). Clinical relevance of adjustment disorder in DSM-III-R and DSM-IV. Comprehensive Psychiatry, 36, 454–460
(1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author
(1998). Repetition of parasuicide—ICD-10 personality disorders and adversity. Acta Psychiatrica Scandinavica, 98, 208–213
(1987). Adjustment disorder as a marginal or transitional illness category in DSM-III. Archives of General Psychiatry, 44, 567–572
(1979). Undiagnosed psychiatric illness in adolescents: A prospective and seven-year follow-up. Archives of General Psychiatry, 35, 279–281
(1989). Consultation liaison psychiatry in a Kuwaiti general hospital. International Journal of Social Psychiatry, 35, 274–279
(1998). Psychiatric diagnoses of previous suicide attempters, first-time attempters, and repeat attempters on an adolescent inpatient psychiatry unit. Journal of the American Academy of Child & Adolescent Psychiatry, 37, 924–932
(1995). Adjustment disorder as an admission diagnosis. American Journal of Psychiatry, 152, 459–461
(1999). Outcome for adjustment disorder with depressed mood: Comparison with other mood disorders. Journal of Affective Disorders, 55(1), 55–61
(1998). Kaplan and Sadock's synopsis of psychiatry: Behavioral sciences, clinical psychiatry (8th ed). Baltimore: Williams & Wilkins
(1998). Suicidality in borderline personality disorder. Crisis, 19, 125–135
(1995). Criterion and predictive validity of the diagnosis of adjustment disorder: A prospective study of youth with new-onset insulin-dependent diabetes mellitus. American Journal of Psychiatry, 152, 523–528
(1994). A controlled prospective study of DSM-III adjustment disorder in childhood: Short-term prognosis and long-term predictive validity. Archives of General Psychiatry, 51, 535–541
(1999). Toward a clinical model of suicidal behavior in psychiatric patients. American Journal of Psychiatry, 156, 181–189
(1994). The longitudinal pattern of suicidal behavior in borderline personality disorder: A prospective follow-up study. Acta Psychiatrica Scandinavica, 90, 124–130
(1990). Attempted suicide in the armed forces: A retrospective study of Norwegian conscripts. Military Medicine, 155, 596–600
(1996). A study of deliberate self-poisoning in patients with adjustment disorders. Folia Medica (Plovdiv), 38(3-4), 11–16
(1999). Assessing varying degrees of lethality in depressed adolescent suicide attempters. Acta Psychiatrica Scandinavica, 99, 423–431
(1992). Adjustment disorder in children and adolescents. Journal of American Academy of Child & Adolescence Psychiatry, 31, 318–326
(1989). Predictors of suicide in borderline personality disorder. Canadian Journal of Psychiatry, 34, 8–9
(1998). Characteristics of suicidal attempts in major depression versus adjustment reactions. Journal of Affective Disorders, 47(1-3), 159–167
(1998). Upregulation of the platelet serotonin 2A receptor and low blood serotonin in suicidal psychiatric patients. Neuropsychobiology, 38, 84–89
(1997). Suicide attempters in a psychiatric emergency room population. General Hospital Psychiatry, 19, 119–129
(1990). Differentiating major depression from adjustment disorder with depressed mood in the medical setting. General Hospital Psychiatry, 12, 159–165
(1994). Risk factors for suicidal behavior in borderline personality disorder. American Journal of Psychiatry, 151, 1316–323
(1998). Adjustment disorder: a multisite study of its utilization and interventions in the consultation-liaison psychiatry setting. General Hospital Psychiatry, 20, 139–149
et al(1989). Critical issues in the review of diagnostic criteria for “adjustment disorders” and “psychological factors affecting physical condition”. General Psychiatry, 11, 153–155
(2000). Neurochemical variables in subjects with adjustment disorder after suicide attempts. European Psychiatry: The Journal of the Association of European Psychiatrists, 15, 190–195
(1997). The prediction of suicidal intent in depressed patients. Acta Psychiatrica Scandinavica, 96, 254–9
(1999). Suicidal behavior among young people in Singapore. General Hospital Psychiatry, 21(2), 128–133