Deconstructing depression: specific symptoms predict future suicide attempts among clinical adolescents

Depression is a risk factor for suicide attempt, but its ability to differentiate individuals at heightened risk as a total score falls short. Prospective investigations of individual depressive symptoms in relation to adolescent suicide attempt are limited and seldom control for established risk factors such as attempt history and other depressive symptoms. Participants (n = 854) were suicidal adolescents enrolled in intensive outpatient treatment targeting suicidality. Depressive symptoms (composite measures of mood, sleep, appetite/weight, and psychomotor disturbance, as well as single-item measures of disturbed concentration, negative self-appraisal, suicidal ideation (SI), anhedonia, and low energy) were measured at entry. Suicide attempts between treatment entry and six months after discharge were recorded (n = 156; 'future attempters'). Bivariate comparisons found significant differences between future attempters and non-attempters on all depressive symptoms besides appetite/weight and psychomotor disturbances. Logistic regression showed that only sleep disturbance and SI contributed to future attempt while controlling for age, sex, attempt history, and other depressive symptoms. A subsequent model revealed that middle and late insomnia largely accounted for sleep's relationship with future attempt. Age, attempt history, and SI were significant predictors in both models. Difficulty with maintaining sleep, early morning awakenings, and severe SI might signal an additional warning for proximate suicide attempt, particularly in youth with attempt history. These results support the measurement of deconstructed depressive symptoms as a practical addition to risk assessment for clinicians managing suicidal adolescents. Such specific risk indicators might signal the need for more intensive care and closer post-discharge monitoring.