Cognitive Characteristics of Adolescent Suicide Attempters ANTHONY SPIRITO, PH.D., JAMES OVERHOLSER, PH.D.,

AND

KATHLEEN HART, PH.D.

Abstract. The present study examined the relationship among psychiatric diagnosis, depression, attributional style, and hopelessness among 69 adolescent suicide attempters and 40 psychiatrically hospitalized adolescent controls. Contrary to predictions, the suicide attempters were more likely than the nonsuicidal group to attribute good events to global causes. No differences in attributional style were found across the depressed versus nondepressed subjects. However, there was a modest relationship between depression and attributional style. Results suggest that maladaptive cognitive characteristics are present in adolescent clinical samples but may be less specific to suicide attempters than is often suggested. J. Am. Acad. Child Adolesc. Psychiatry, 1991,30,4:604-608. Key Words: adolescents, suicide attempts, hopelessness, attributional style. Cognitive variables have become of increasing interest to researchers who study suicidal behavior (Arffa, 1983). These cognitive characteristics, such as problem-solving deficits or rigidity/inflexibility, hopelessness, and attributional style are important variables in several models of suicidal behavior (e.g., Bonner and Rich, 1988; Schotte and CIum, 1982, 1987). Asarnow et a!. (1987) and Cohen-Sandler (1982) found that psychiatrically hospitalized suicidal children generated fewer active coping strategies than nonsuicidal children. Two studies with adolescents confirmed the findings with children. Adolescent suicide attempters demonstrated less flexibility in problem solving (Levenson and Neuringer, 1971) and generated fewer ways to solve problems (Trautman, 1987) than did nonsuicidal, psychiatrically disturbed adolescents. Hopelessness and attributional style are two other cognitive constructs that may be pertinent to suicide attempters. Hopelessness has been found to increase in proportion to the severity of suicidal ideation in child and adolescent psychiatric patients (Carlson and Cantwell, 1982). When the samples were composed of child psychiatric inpatients severity of children's suicidal tendencies (i.e., from ideation to attempt) was significantly associated with children's selfreports of hopelessness (Asarnow and Guthrie, 1989; Kazdin et a!., 1983). Suicide attempts were also significantly associated with both hopelessness and a diagnosis of depression (Asarnow and Guthrie 1989). Studies with adolescents have been mixed. In a nonclinical sample of high school students, Cole (1989) demonstrated that after controlling for depression, hopelessness maintained a modest correlation with suicidal behavior for girls (r = 0.47) but not for boys (r = 0.00). Spirito et a!. (1988) demonstrated that adolescent suicide attempters have a higher level of hopelessness than nonsuicidal psychiatric outpatients, while another study (Rotheram-Borus and Trautman, 1988) did not find this to

be true. Brent et a!. (1989) studied 50 suicidal, psychiatrically hospitalized adolescents and 34 nonsuicidal psychiatric controls. The suicidal group reported a higher level of hopelessness than the nonsuicidal group. The conflicting findings on level of hopelessness between . adolescent suicide attempters and nonsuicidal psychiatric outpatients suggest that this question requires further study. In addition, although attributional style has been the subject of many research projects (Sweeney et a!., 1986), few studies have investigated attributional style among adolescents. Two studies (Curry and Craighead, in press; Saylor et a!., 1984) found moderate correlations between attributional style and self-reported depression. Curry and Craighead (1990) also found that adolescent inpatients with diagnoses of major depression were less likely to attribute positive events to internal, stable, and global causes than nondepressed adolescents. Because adolescent suicide attempts are most often precipitated by common stressful events (Spirito et aI., 1989), the manner in which these adolescents evaluate events is of particular interest. For example, Brent et al. (1989) found that psychiatrically hospitalized suicide attempters demonstrated greater cognitive distortion than nonsuicidal inpatient psychiatric controls. The present study was designed to extend previous research by examining specific cognitive characteristics (i.e., attributional style and hopelessness) in adolescent suicide attempters compared with a group of nonsuicidal, psychiatrically hospitalized adolescents. In addition, because these cognitive characteristics have been shown to be related to depression in children (Benfield et a!., 1988; Kaslow et a!., 1988; McCauley et a!., 1988; Seligman et a!., 1984), the extent to which these cognitive variables are mediated by level of depression and diagnosis of affective disorder was also investigated. Method

Accepted December 10, 1990. Dr. Spirito isfrom Rhode Island Hospital/Brown University, Providence, Rhode Island; Dr. Overholser is from Case Western Reserve University, Cleveland, Ohio; and Dr. Hart isfrom Xavier University, Cincinnati, Ohio. Reprint requests to Dr. Spirito, Child and Family Psychiatry, Rhode Island Hospital, 593 Eddy Street, Providence, Rhode Island 02903. 0890-8567/9113004-0604$03.00/0© 1991 by the American Academy of Child and Adolescent Psychiatry.

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Subjects

The suicidal group consisted of 69 adolescents hospitalized on the general pediatrics floor of a large metropolitan hospital after a suicide attempt. Subjects were admitted after a medical evaluation in the emergency room. Medical intervention ranged from intensive care management to routine observation. After their medical hospitalization, 30% J. Am .Acad. Child Adolesc.Psychiatry, 30:4, July 1991

ADOLESCENT SUICIDE ATTEMPTERS

were transferred to a psychiatric hospital for additional treatment. The majority of the suicide attempters were female (55 females, 14 males), with ages ranging from 12 to 17 years and a mean age of 15.3 (SD = 1.4) years. Ninetyone percent of the sample were white, and 42% were on welfare. Drug overdoses comprised 91 % of the suicide attempt methods. A consensus diagnosis was assigned by a child psychiatry fellow and the attending child psychiatrist after clinical interviews with patients and their parents/ guardians. For the purposes of this study, they were classified into one of four broad diagnostic categories: adjustment reaction (46%), major depression or dysthymia (32%), conduct disorder (17%), and other diagnoses (5%). These diagnostic groupings allowed statistical comparison between the suicide attempters and psychiatric controls on distribution of diagnoses. The psychiatric control group was comprised of 40 adolescents admitted to a children's psychiatric hospital in a large metropolitan area. The group was made up of 23 females and 17 males, with ages ranging from 12 to 17 years and a mean age of 14.7 (SD = 1.7) years. Eighty percent of the patients were white, and 65% of their families were on welfare. Diagnoses upon admission were primarily conduct disorder (37%), adjustment reaction (15%), major depression or dysthymia (35%), and other assorted diagnoses (13%). None of these patients were admitted after a suicide attempt nor did any have a previous history of suicide attempts. Adolescents who were psychotic, actively suicidal, or intellectually limited (IQs below 85) were excluded from this group. Procedure

All subjects were administered the dependent measures as part of a comprehensive psychological diagnostic assessment conducted within the first few days of their admission to the psychiatric hospital and within 24 hours of medical stabilization on the pediatrics floor. They were seen by members of the psychology staff that consisted of clinical psychologists and psychology trainees. To ensure understanding, most measures were read to the subject and recorded by the examiner. Dependent Measures The Children's Depression Inventory (CD/). The CDI (Kovacs, 1980/1981) is a 27-item self-report measure of depression designed specifically for children and adolescents. Each item uses a set of three sentences to describe a different depressive symptom, such as sleep or appetite disturbance, dysphoric mood, etc. Items are scored 0, 1, or 2, resulting in a potential range of scores from 0 to 54. High internal consistency scores have been reported with this instrument in both normal and clinical samples (Saylor et al., 1984). Acceptable test-retest reliability coefficients, ranging from 0.38 to 0.87, have also been reported (Saylor et aI., 1984). The Hopelessness Scale for Children (HSC). The HSC (Kazdin et aI., 1986) is a 17-item true/false questionnaire that measures feelings of pessimism and hopelessness about the future. Because Kazdin et al. (1986) recommend exl.Am.Acad. Child Adolesc. Psychiatry, 30:4, luly 1991

eluding one item from the scale as a result of poor psychometric characteristics, scores range from a to 16 with one point being assigned to each statement endorsed in the "hopeless" direction. Kazdin et al. (1986) have reported adequate internal consistency (alpha = 0.97) and test-retest reliability (r = 0.52). Also, construct validity studies using child psychiatric inpatients (Kazdin et al., 1986) have found the scale to correlate positively with depression (r = 0.58) and negatively with self-esteem (r = -0.61) and social skills (r = - 0.39). Children's Attributional Style Questionnaire (CASQ). The CASQ (Kaslow et aI., 1981, unpublished manuscript) is a 48-item scale in which the individual chooses, from a pair of possible causes, the reason that best explains why a good or bad event occurred. The CASQ subscales are based on the attributional dimensions described by Abramson et al. (1978): internal/external, global/specific, and stable/unstable. There are six subscales with eight items each. Three subscales reflect internal, stable, and global attributions for negative events, while three reflect these same attributions for positive events. A negative composite score, a positive composite score, and a summary score can all be derived. Studies using normal samples of children have found the attribution of bad events to internal, stable, global causes correlates significantly with CDI scores (composite rs range from 0.39 to 0.51), while the reverse attributional style (attributing good events to external, unstable, and specific causes) also correlates with this measure of depression (composite rs range from 0.44 to 0.54; Kaslow et al., 1984; Seligman et aI., 1984). CASQ scores have also been found to be stable over a 6-month interval (Seligman et al., 1984). Results Preliminary Analyses

Analyses were conducted in order to evaluate differences between the suicide attempters and psychiatric controls on demographic variables: age, sex, and welfare status. The suicide attempters were found to be slightly older than the psychiatric controls, t(107) = 2.02, p < 0.05. However, all of the correlations between age and the CASQ subscales and composite scales were lower than 0.09 and not statistically significant. Also, the proportion of males was higher in the psychiatric control group than the suicide attempters, x2(l, N = 108) = 5.09, p < 0.05. However, a series of t-tests did not reveal statistically significant differences by sex on any of the CASQ subscales. In order to examine the effects of SES on the dependent measures, the sample was divided by welfare status. There was a greater percentage of psychiatrically hospitalized patients than of the suicide attempters on welfare, X2(2) = 4.34, p < 0.05. Chi-square analyses did not reveal any differences between welfare and nonwelfare subjects by sex, x2(l) = 0.09, NS. The t-tests did not reveal any difference between the welfare/nonwelfare groups in age, t(98) = 0.64, NS; CDI total score, t(97) = 0.51, NS; or HSC total score, t(98) = 0.55, NS. A series of t-tests were also conducted using CASQ subscales and welfare status. Only one significant difference was found: subjects on welfare ob605

SPIRITO ET AL.

tained a higher score eX = 3.1, SO = 1.5) than the insured subjects ()( :; 2.3, SO = 1.6) on the Bad Global subscale of the CASQ, t(98) = 2.50, P < 0.01. Suicide attempters were compared with psychiatric controls on their Axis I diagnosis (depression, adjustment reaction, and conduct disorder). There was a higher proportion of conduct disorder diagnoses and lower proportion of adjustment reaction diagnoses in the psychiatric group, as compared with the suicide attempters, X2(2,N = 108) = 13.52, P < 0.001. Chi-square analyses did not reveal any difference in distribution of diagnoses between welfare versus insured subjects, X2(2) = 0.38, NS. A t-test examining the COl total score by welfare status was not statistically significant, t(97) = 0.66, NS. As partial validation of the diagnoses, an analysis of covariance (ANCOVA) examing cm total scores by diagnostic category and sex while controlling for age was conducted. There was a significant main effect for diagnosis, F(2,94) = 4.70, P < 0.01. Patients diagnosed with depression or adjustment disorders had significantly higher cm scores than those diagnosed with conduct disorders. Primary Analyses Depression. The means, standard deviations, and F-values on the cm, HSC, and CASQ scales can be found in Table I. Since the suicide attempters and psychiatric controls differed by age and sex, an ANCOVA was conducted to examine differences on the COl total score by group and sex while controlling for age. The Bonferroni correction was employed in order to control for multiple comparisons. Therefore, findings of p < 0.005 were considered statistically significant for the t-tests and for the ANCOVA findings that follow. No significant differences were found. Hopelessness. An ANCOVA was conducted to examine sex and group differences on the HSC while controlling for age and depression, as measured by the COL A group by sex interaction effect was found on the HSC, F(l, 105) = 5.09, P < 0.05. Female suicide attempters eX = 7.4, SO = 4.3) had higher scores on the HSC than the female psychiatric patients eX = 4.4, SO = 4.3), but male psychiatric patients (X = 6.3, SO = 4.4) had higher scores on the HSC than male suicide attempters (X = 4.0, SO = 2.6). An ANCOVA was also used to examine scores on the HSC by sex and diagnostic category while controlling for age and depression. None of the main effects or interaction effects were statistically significant. Attributional style. Separate analyses were conducted with the CASQ subscales. ANCOVAs examining sex and group differences while controlling for age and level of depression found suicide attempters to differ significantly from the psychiatric controls only on the Good-Global scale of the CASQ (Table 1). Suicide attempters were more likely than the psychiatric controls to attribute good events to global causes. Because preliminary analyses revealed a difference on the Bad Global subscale of the CASQ by welfare status, ANCOVAs examining group and welfare status while controlling for age and depression severity were also conducted. These analyses revealed a main effect for welfare status on

606

TABLE

I. Means. Standard Deviations. and F Values for Self-Report Measures across Groups

Suicide Attempters (N = 69) Measures COl HSC CASQ scales Good-internal Good-global Good-stable Bad-internal Bad-global Bad-stable Composite-positive Composite-negative Summary score

Psychiatric Controls (N

=

40)

X

SO

X

SO

F Value

17.8 6.7

9.2 4.2

14.5 5.2

8.9 4.4

1.77 0.18"

3.7 4.6 3.7 3.8 2.5 3.0 12.1 9.3 2.9

1.7 1.4 1.4 1.5 1.5 I. 7 3.2 3.5 5.5

4.2 3.9 3.5 3.5 2.8 2.2 11.6 8.6 3.1

1.7 1.5 2.1 1.5 1.7 1.7 3.4 3.4 5.4

0.19 12.27* 0.24 0.35 2.09 I. 76 2.98 0.05 0.97

Note. COl = Children's Depression Inventory; HSC = Hopelessness Scale for Children; CASQ = Children's Attributional Style Questionnaire; F values on the HSC and CASQ scales refer to the main effect for group using an ANCOV A examining group and sex differences while controlling for age and depression (COl total score). ''There was a group by sex interaction effect on the HSC. *p < 0.05 (Bonferroni corrected).

the Good Global subscale, F(I,93) = 6.63, P < 0.01 and Bad Global subscale, F(l,93) = 4.48, P < 0.05. The subjects on welfare obtained a higher score on the Bad Global subcale than the insured subjects (see Preliminary Analyses). The subjects on welfare (X = 4.1, SO = 1.6) also obtained a lower score on the Good Global subscale than the insured subjects eX = 4.7, SO = 1.5). There was also an interaction effect for group x welfare status on the Good Internal subscale, F(l,93) = 5.23, P < 0.05, and group x welfare status on the Bad Stable subscale, F(I,93) = 4.69, P < 0.05. The psychiatric controls on welfare eX = 4.7, SO = 1.7) obtained higher scores on the .,good internal subscale than the insured suicide attempters ()( = 3.9, SO = 1.8), suicide attempters on welfare (X = 3.5, SO = 2.0), or insured psychiatric controls (X = 3.9, SO = 2.2). On the Bad Stable subscale, the psychiatric controls on welfare (X = 1.8, SO = 1.4) had significantly lower scores than the suicide attempters on welfare (X = 3.2, SO. = 2.1). Diagnostic category. In order to examine possible differences in attributional style by diagnostic category, the entire sample was divided by diagnosis: conduct disorder versus depression. ANCOVAs examining diagnostic category and sex while controlling for age and level of depression (i.e., cm total score) did not reveal any differences on the CASQ subscales, composite scales, or summary score by diagnosis or sex. Interrelationships of depression, hopelessness, and attributional style. Pearson product-moment correlation coefficients were computed to examine the relationships among the measures administered. The Bonferroni correction was employed to account for the number of correlations coml.Am.Acad. Child Adolesc.Psychiatry, 30:4, luly 1991

ADOLESCENT SUICIDE ATTEMPTERS

2. Pearson-Product Moment Correlation Coefficients between the Children's Depression Inventory (CD/) and Hopelessness Scale for Children (HSC) Total Scores and the Children's Attributional Style Questionnaire (CASQ) Scales for the Entire Sample (N = 109).

TABLE

Measures CASQ Scales Good-internal Good-global Good-stable Bad-internal Bad-global Bad-stable Composite-positive Composite-negative Summary score

COl

HSC

-0.43* -0.11 -0.17 0.30* 0.30* 0.44* -0.37* 0.49* -0.54*

-0.28* -0.13 -0.07 0.25 0.36* 0.31* -0.25 0.43* 0.43*

*p < 0.05 (Bonferroni corrected).

puted. Findings of p < 0.003 are considered statistically significant. The COl and HSC were highly correlated, r(106) = 0.69, p < 0.001. Significant inverse correlations were found between the COl total score and the CASQ GoodInternal and Composite-Positive scales. Significant positive correlations were found between the CDI and the Bad-Internal, Bad-Global, Bad-Stable scales, and Composite-Negative scales. The correlations of the CASQ with the HSC were less strong. A significant inverse correlation with the Good-Internal scale and significant positive correlations with the Bad-Global, Bad-Stable, and Composite-Negative scales were found. These results are presented in Table 2. Multiple regression analyses were conducted in order to examine the relationship between attributional style and depression for both patient groups combined. When COl total score was used as the dependent variable, age, sex, and group (suicide attempters, psychiatric controls) were entered first, accounting for only 4.9% of the variance, F(3,102) = 1.74, NS. The six scales of the CASQ were entered next and accounted for an additional 29.3% of the variance, F(9,96) = 7.14, p < 0.001. This suggests that attributional style is significantly related to depression severity even after controlling for demographic differences and suicide attempt status across subjects. Discussion

When adolescent suicide attempters were compared with a sample of nonsuicidal, psychiatrically hospitalized adolescents, relatively few differences were found on the cognitive variables of hopelessness and attributional style. The scores on the HSC were higher than that reported for adolescents in outpatient treatment (Spirito et aI., 1988), juvenile delinquents (Cole, 1989), and normal adolescents (Spirito et al., 1988). Gender effects on hopelessness similar to those reported by others (e.g., Cole, 1989) were also found. A group by sex interaction effect was seen on hopelessness, with female suicide attempters reporting slightly higher levels than male psychiatric patients, while female psychiatric controls and male suicide attempters obtained the lowest scores. The greater percentage of conduct-disI.Am.Acad. Child Adolesc. Psychiatry, 30:4,July 1991

ordered youth among male suicide attempters compared with female suicide attempters may account for these findings. The CASQ composite positive and negative scores of the psychiatric sample were very similar to that reported by Curry and Craighead (1990). On the CASQ, only one of the scales was found to differentiate the two groups: suicide attempters were more likely than the nonsuicidal controls to attribute good events to global causes. This finding may be related to the fact that many suicide attempts resulted in a positive response from parents and other family members. A study with adult psychiatric inpatients (Ellis et aI., 1989) found that suicidal patients had a more negative attributional style than nonsuicidal patients, a finding somewhat discrepant from the present study. Thus, maladaptive attributional style among adolescents may be more a function of general psychopathology than specific symptomatology (Benfield et aI., 1988). Differences in attributional style by diagnostic group were not detected. However, patients on welfare were more likely to attribute bad events to global causes and good events to specific causes. This finding suggests that attributional style is a complex construct affected by both psychological and social variables. Depression and hopelessness were related to attributing good outcomes to external factors but not unstable and specific factors. This finding stands in contrast to some studies with normal children that have found a strong relationship between attributional style for good events and depression (Bodiford et aI., 1988; Seligman et aI., 1984) and another that found only the summary score of the CASQ to be related to depression (Robins and Hinkley, 1989). Differences across studies may be related to level of depression within normal versus clinical samples as well as differences in the scales used to assess depression (Robins and Hinkley, 1989). A moderate relationship was found between depression and a cognitive style in which bad events were attributed to internal, stable, and global factors. These results are similar to those with nonclinical child samples (Kaslow et aI., 1984; Seligman et aI., 1984). Several limitations of this study should be mentioned. Differences in sample characteristics necessitated covarying several important variables in the statistical analyses. Use of a paper-and-pencil measure to assess attributional style and depression might not be adequate. Similarly, structured interviews are preferable when determining diagnoses in psychiatric samples. A maladaptive attributional style might be more evident in patients where comorbidity was evident, whether or not they are suicide attempters. Among suicide attempters, lethality of the suicidal method, suicide intent, and history of previous suicide attempts should also be considered in future studies and might be related to the extent of dysfunctional attributions. Nonetheless, the consistent lack of relationships in this study suggests that a specific attributional style does not exist among adolescent suicide attempters. A negative attributional style appears more strongly related to self-reported depression than suicidal behavior. However, because attributional style did not differ by interviewer-rated diagnostic categories (depression versus conduct disorder), the relationship between the CDI and CASQ subscales might be a function of method variance.

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Alternatively, the relationship may be a function of the presence or absence of psychopathology (Benfield et aI., 1988; Seligman and Peterson, 1986), or mediated by other cognitive factors, such as problem-solving (Nezu et aI., 1986). Understanding the cognitive style of various adolescent groups with differing diagnoses and presenting problems will be helpful in expanding our knowledge. Future research might evaluate cognitive characteristics among other adolescent groups to help achieve that end. Clinicians working with adolescent suicide attempters may need to focus more on issues of depression and hopelessness and less on attributional style. Results from the present study suggest that a negative attributional style is not directly related to suicidal tendencies. Attributions may refer to past events, whereas expectations pertain to future possibilities. The literature on hopelessness suggests that suicidal behavior is closely tied to negative expectations regarding the future. Hence, attributions regarding the causal nature of past events may not playa strong role in the assessment or treatment of suicidal tendencies in adolescents. Nonetheless, negative attributional style may still be relevant to depression. These dysfunctional attributions may be a useful focus in time-limited therapy with depressed adolescents, whether they have made a suicide attempt or not.

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self-reported depression among adolescent inpatients. Child Family Behavior Therapy. - - - - (1990), Attributional style in clinically depressed and conduct disordered adolescents. J. Consult. Clin. Psychol., 58:109115. Ellis, T. E., Berg, R. & Franzen, M. (1989), Organic and cognitive deficits in suicidal patients. Poster presented at the 22nd Annual Meeting of The American Association of Suicidology, San Diego, CA. Kaslow N. J., Rehm, L. P. & Siegel, A. W. (1984), Social and cognitive correlates of depression in children: a developmental perspective. J. Abnorm. Child Psychol., II :497-502. - - - - Pollack, S. L. & Siegel, A. W. (1988), Attributional style and self-control behavior in depressed and nondepressed children and their parents. J. Abnorm. Child Psycol .. 16: 163-175. Kazdin, A. E., French, N. H., Unis, A. S., Esveldt-Dawson, K. & Sherrick, R. B. (1983), Hopelessness, depression, and suicidal intent among psychiatrically disturbed inpatient children. J. Consult. Clin. Psychol .. 51:504-510. - - Rodgers, A. & Colbus, D. (1986), The Hopelessness Scale for Children: Psychometric characteristics and concurrent validity. J. Consult. Clin. Psychol., 54:241-245. Kovacs, M. (1980/1981), Rating scales to assess depression in schoolaged children. Acta Paedopsychiatry. 46:305-315. Levenson, M. & Neuringer, C. (1971), Problem-solving behavior in suicidal adolescents. J. Consult. Clin. Psychol., 37:433-436. McCauley, E., Mitchell, J., Burke, P. & Moss, S. (1988), Cognitive attributes of depression in children and adolescents. J. Consult. Clin. Psychol .• 56:903-908. Nezu, A. M., Kalmar, K., Ronan, G. F. & Clavijo, A. (1986), Attributional correlates of depression: an interactional model including problem-solving. Behav. Ther .. 17:5Q-56. Robins, C. J. & Hinkley, K. (1989), Social-cognitive processing and depressive symptoms in children: a comparison of measures. J. Abnorm. Child Psychol., 17:29-36. Rotheram-Borus, M. J. & Trautman, P. D. (1988), Hopelessness, depression, and suicidal intent among adolescent suicide attempters. J. Am. Acad. Child Adolesc. Psychiatry, 27:700-704. Saylor, C. F., Finch, A. J., Spirito, & Bennett, B. (1984), The Children's Depression Inventory: a systematic evaluation of psychometric properties. J. Consult. Clin. Psychol., 52:955-967. Schotte, D. E. & Clum, G. A. (1982), Suicide ideation in a college population: a test of a model. J. Consult. Clin. Psychol., 50:69Q696. - - - - (1987), Problem-solving skills in suicidal psychiatric patients. J. Consult. Clin. Psychol., 55:49-54. Seligman, M. E. P. & Peterson, C. (1986), A learned helplessness perspective in childhood depression: theory and research. In: Depression in Young People: Developmental and Clinical Perspectives. eds. M. Rutter, C. E. Izard & P. B. Read. New York: Guilford. - - - - Kaslow, N. J., Tanenbaum, R. L., R. L., Alloy, L. B. & Abramson, L. Y. (1984), Attributional style and depressive symptoms among children. J. Abnorm. Psychol., 93:235-238. Spirito, A., Williams, c., Stark, L. J. & Hart, K. (1988), The Hopelessness Scale for Children: psychometric properties and clinical utility with normal and emotionally disturbed adolescents. J. Abnorm. Child Psychol., 16:445-458. - - Overholser, J. & Stark, L. J. (1989), Common problems and coping strategies II: findings with adolescent suicide attempters. J. Abnorm. Child Psychol., 17:213-221. Sweeney, P. D., Anderson, K. & Bailey, S. (1986), Attributional style in depression: a meta-analytic review. J. Pers. Soc. Psychol., 50:974-991. Trautman, P. D. (1987), Adolescent suicide attempters: deficits in cognitive style or anhedonia? Poster presented at The Annual Meeting of The American Academy of Child and Adolescent Psychiatry, New York.

J.Am.Acad. Child Adolesc. Psychiatry, 30:4, July 1991

Cognitive characteristics of adolescent suicide attempters.

The present study examined the relationship among psychiatric diagnosis, depression, attributional style, and hopelessness among 69 adolescent suicide...
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