All treatments received at any point in the six months prior to each follow-up are noted in . Individual psychotherapy was the most commonly received form of treatment with pharmacotherapy treatment only slightly less common throughout the 2 years of follow-up. Medications prescribed at T1 were (number of adolescents prescribed medication; percentage): Antidepressants (N=32; 37.6%), Mood Stabilizers (N=14; 16.5%), Antipsychotics (N=5; 5.9%), Stimulants (N=3; 3.5%), and Anti-Parkinsonian (N=1; 1.2%). A sizable percentage of adolescents utilized school counselors and psychologist, in addition to family and group therapies. In general, the percentages of adolescents receiving any services dropped across time.
Numbers (Percentages) of Adolescents Receiving Services at Least Once in the Six Months Prior to Each Time Point
The two most commonly reported mental health services, individual psychotherapy and pharmacotherapy, were examined in subsequent analyses. Adolescent and parent ratings of the helpfulness of these two treatments are presented in .
Adolescent and Parent Ratings of Treatment Helpfulness: Numbers (Percentages) among Participants who Received Each Form of Treatment, Time 2–5
The percentages of participants who were non-compliant with individual psychotherapy and pharmacotherapy were assessed at each time point. Rates of non-compliance at each time point are noncumulative, and are independent of one another, as non-compliant participants could return to treatment in a compliant fashion at later time points. Non-compliance rates for individual psychotherapy for each time point were: 17.6% (T2), 21.6% (T3), 18.2% (T4), and 35.7% (T5). For pharmacotherapies the rates were 25.0% (T2), 27.7% (T3), 19.4% (T4), and 11.1% (T5). Over the course of the 2-year follow-up, 57.7% of participants were non-compliant at some point with individual psychotherapy and 41.3% were non-compliant with medications.
Sixteen adolescents (18.8%) reported making at least one repeat suicide attempt during the 2-year follow-up period, comprised of 13 of the 62 (21%) females and 3 of the 23 (13%) males in the study. There were no significant differences in rates of repeated suicide attempt by gender, age at index attempt, or family socio-economic status. The numbers of adolescents who reported making their first repeated attempt at each time point were 11 at the initial 6-month (T2) period, 4 at T3, 0 at T4, and 1 at T5. Of the 16 adolescents who reported suicidal behavior during the 2-year follow-up, 7 made multiple attempts.
Adolescent Variables and Treatment Compliance
Adolescent baseline psychopathology
At baseline (T1), adolescents met criteria for the following psychiatric DISC diagnoses: Major Depressive Disorder (N=47, 57.3%), Dysthymia (N=39, 47.6%), Bipolar Disorder (N=5, 6.1%), Generalized Anxiety Disorder (N=20, 24.1%), Conduct Disorder (N=23, 27.1%), Oppositional Defiant Disorder (N=27, 31.8%), Attention Deficit/Hyperactivity Disorder (N=10, 11.8%), Substance Dependence (N=20, 23.5%), Marijuana Dependence (N=22, 25.9%), Alcohol Dependence (N=19, 22.4%). Adolescents’ diagnoses were grouped to form broadband binary diagnosis variables of any affective or anxiety disorder (major depressive disorder, dysthymia, bipolar disorder, generalized anxiety disorder) and any disruptive behavior disorder (conduct disorder, oppositional defiant disorder, attention-deficit/hyperactivity disorder). Fifty-two (61.2%) adolescents had one or more affective/ anxiety diagnosis and 36 (42.4%) adolescents had one or more disruptive behavior diagnosis. Twenty-eight (32.9%) adolescents had both affective/anxiety and disruptive behavior diagnoses, while 32 (37.7%) adolescents had no diagnosis within either affective/anxiety or disruptive behavior categories.
Discrete Time Survival Analyses (DTSA) were run to analyze the effects of adolescent affective/anxiety as well as disruptive disorders on the probability of treatment compliance for individual psychotherapy and pharmacotherapy. The results of the regression of the survival function on the predictor variables indicated that having a disruptive behavior diagnosis at baseline was predictive of an increased risk of non-compliance with individual psychotherapy as compared to adolescents with no disruptive behavior diagnosis (β = 1.045, S.E. = 0.382, p < .01). Survival plots for adolescents with and without a disruptive behavior disorder are shown in for individual psychotherapy. When the hazard analyses were run for medication non-compliance, adolescents with an affective/anxiety diagnosis at baseline, as compared to all other adolescents in the sample, were at increased risk of medication non-compliance at the 6-month follow-up (β = 1.451, S.E..= 0.715, p < .05), but not at later time points (see for plots of survival curves).
Survival plots comparing the cumulative probability of remaining compliant with individual psychotherapy by month for each of the significant dichotomous independent variables.
Survival plots comparing the cumulative probability of remaining compliant with pharmacotherapy by month for each of the significant dichotomous independent variables.
DTSA analyses were also conducted examining the associations of dependence on alcohol, marijuana, or other substances with non-compliance with individual therapy and pharmacotherapy. Neither alcohol nor marijuana dependence were predictive of non-compliance with either form of treatment. However, the regression of the survival function for non-compliance with individual therapy on dependence on other substances yielded a significant effect, (β = 1.274, S.E. = 0.405, p < .01), indicating that suicidal youths with a substance dependence disorder were quicker to drop out of individual therapy, as shown in .
Adolescent rating of treatment helpfulness
DTSA were run to test for influence of adolescents’ ratings of helpfulness of individual psychotherapy or pharmacotherapy on the probability of non-compliance with that treatment. None of these survival analyses yielded significant results, indicating that adolescents’ helpfulness ratings for a given therapy did not predict how long they complied with that therapy.
Parent Variables and Treatment Compliance
DTSA analyses were run to examine whether a history of one or more disorders in mothers or fathers was predictive of adolescent compliance with individual psychotherapy or pharmacotherapy. None of the analyses were significant.
Parental rating of treatment helpfulness
Parental ratings of their children’s individual psychotherapy as helpful were significant predictors of a lower risk of adolescents’ non-compliance with individual psychotherapy over the course of the study (β = −0.551, S.E. = 0.244, p < .05), as illustrated in , but not of pharmacotherapy.
Treatment Compliance and Suicidality
Due to the small number of repeated attempts, DTSA could not be utilized in analyzing the effects of treatment compliance on suicidality. Instead Chi- square analyses were run to examine associations between treatment compliance and repeated suicide attempts, at any time during the follow-up. There were no significant findings.
Regression analyses were run in order to determine if compliance with either individual psychotherapy or medications was predictive of change in suicidal ideation between 6-month follow-ups. Analyses tested the relationship between treatment compliance at each time point and suicidal ideation at the immediately succeeding time point, while controlling for ideation at the previous time point. Preliminary analyses indicated that age at T1, gender, and family socioeconomic status (SES) were not correlated with suicidal ideation at T2, T3, T4, or T5; therefore these variables were not covaried in the regression analyses. Of the regression analyses run, only compliance with pharmacotherapy at T4 predicted decreased suicidal ideation at T5 (F [1, 12] = 6.395, p < .05) after controlling for suicidal ideation at T4.