Personality Type Might Help Identify Teens at Suicide Risk

Studies of adolescents who have attempted suicide usually focus on identifying how they differ from their nonsuicidal peers. Researchers at Emory University, however, have begun to identify how adolescents who attempt suicide differ from one another.

Their work adds to previous studies that have reported personality subtypes within samples of adult suicide attempters and completers. “Overall, assessing adolescents’ risk of suicide attempt should include not only a list of risk factors but also a deeper understanding and consideration of personality,” wrote lead author Dorthie Cross, a doctoral student in the Department of Psychology at emory University, and her colleagues in the October Journal of Nervous and Mental Disease.

The researchers used a Q-factor analysis to identify subtypes based on the Shedler-Westen Assessment Procedure-II for Adolescents (SWAP-II-A), a 200-item measure of personality pathology administered by clinicians that was codeveloped by Drew Westen, one of the authors of the new study.

“Q-factor analysis is also called inverted factor analysis because it aggregates patients rather than variables, identifying people with similar profiles across a set of items instead of items with similar content across cases,” the researchers noted. “the goal of Q-factor analysis in this study is to identify groups of adolescent attempters with shared personality characteristics that distinguish them from other adolescents who have attempted suicide,” they explained.

The researchers recruited 950 psychiatrists and psychologists with at least three years’ postlicensure experience from membership rosters of the American Academy of Child and Adolescent Psychiatry and the American Psychological Association. Participating clinicians were asked to provide data on a single randomly selected adolescent patient currently in treatment of “enduring maladaptive patterns of thought, feeling, motivation, or behavior—that is, personality.” they were asked to select a patient without a particular diagnosis, yielding 267 patients with a history of suicide attempt. Publications detailing the sampling procedure and the rationale for using clinicians as informants in basic science research, also coauthored by westen and published in the American Journal of Psychiatry, were referenced.

Q-factor analysis of the 267 patients with a history of suicide attempt resulted in six subtypes: externalizing, internalizing, emotionally dysregulated, high functioning, narcissistic, and immature.

To validate each subtype, the researchers compared the study subjects across relevant Axis I and Axis II pathology, adaptive functioning, and etiology. “Depression, substance abuse, physical and sexual abuse, attachment disruption, and particular personality characteristics (e.g., impulsivity or neuroticism) are all markers for risk; however, these markers do not apply, nor can they apply, to all suicidal adolescents,” they explained.

In discussing the limitations of their study, Cross and colleagues noted that only adolescents who attempted, rather than completed, suicide were able to be evaluated, potentially omitting meaningful subtypes, though they cited increasing evidence that suicide attempt and completion constitute a single spectrum of risk.

“Despite its limitations, this study shows that the path to suicide may be quite different depending on what type of person is making the decision,” concluded Cross and her colleagues. “Understanding those differences is vital to the prediction and prevention of future suicide attempts.”

The research was funded by a grant from the National Institute of Mental Health.

An abstract of “Personality Subtypes of Adolescents Who Attempt Suicide” is posted at <www.ncbi.nlm.nih.gov/pubmed/21964268>.