This proposed three-year project is a competitive renewal of """"""""Psychiatric Effects of Exposure to Suicide in Youth,"""""""" mh44711-03. In the original project, which began February 1, 1989, a community sample of 174 adolescents exposed to suicide was psychiatrically assessed six months after exposure, and compared to an equal number of demographically matched, unexposed community controls. The exposed group consists of 25 siblings, 80 friends, and 69 acquaintances of 26 suicide victims, all in the adolescent age range. These exposed and unexposed subjects are currently being followed up by phone one year after the initial interview (18 months after exposure). The phone follow-up will be completed during the original project period. In the proposed project, we plan to finish data analysis and prepare manuscripts based on the first two waves of data. We also plan to follow up all exposed subjects and controls in face-to-face interviews three years after the initial interview (3.5 years after exposure).
The aims of the proposed project will be to test the following hypotheses, based upon our interviews at six months, 18 months, and 3.5 years after exposure. Each wave of interviews will be used to ascertain onset and offset of disorder and suicidality from the point of the previous wave of interviews, so that the course of disorder from exposure to 3.5 years after exposure can be delineated. These hypotheses are derived from our preliminary data analyses and the literature: (1) The exposed group will show higher rates of suicidality (ideation with a plan or an attempt), and equal rates of suicide attempts to the unexposed group both at six months after exposure and over the 3.5 year period of observation; (2) The exposed group will show higher rates of major depression and PTSD that had their onset shortly after exposure. Over the subsequent follow-up period, additional new-onset disorders will not be more common in the exposed than control group, with one exception: (3) Those exposed subjects with major depression that began after exposure will be more likely to experience a recurrence of major depression than either those exposed subjects who did not experience a depression, or matched unexposed controls; (4) Among those who are exposed to suicide, depression will be most likely to occur among those with a close relationship with the victim, a previous history of depression, family history of affective disorder, and a history of additional interpersonal losses; (5) Among those exposed to suicide, post- traumatic stress disorder (PTSD) will be most likely to develop among those with a close relationship with the suicide victim, who have witnessed the suicide or have found the body, who had a previous history of psychiatric illness, and a family history of psychiatric disorder; and (6) Persistence of depression and PTSD will be related to initial severity and risk factors for development of the disorder.
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