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Background: Knowledge is lacking on the long-term outcomes of treatment for adolescents with repetitive suicidal and self-harming behavior. Furthermore, the pathways through which treatment effects may operate are poorly understood. Our aims were to investigate enduring treatment effects of dialectical behavior therapy adapted for adolescents (DBT-A) compared to enhanced usual care (EUC) through a prospective 3-year follow-up and to analyze possible mediators of treatment effects., Methods: Interview and self-report data covering the follow-up interval were collected from 92% of the adolescents who participated in the original randomized trial., Trial Registration Number: NCT01593202 (www.ClinicalTrials.gov)., Results: At the 3-year follow-up DBT-A remained superior to EUC in reducing the frequency of self-harm, whereas for suicidal ideation, hopelessness and depressive and borderline symptoms and global level of functioning there were no inter-group differences, with no sign of symptom relapse in either of the participant groups. A substantial proportion (70.8%) of the effect of DBT-A on self-harm frequency over the long-term was mediated through a reduction in participants' experience of hopelessness during the trial treatment phase. Receiving more than 3 months follow-up treatment after completion of the trial treatment was associated with further enhanced outcomes in patients who had received DBT-A., Conclusions: There were on average no between-group differences at the 3-year follow-up in clinical outcomes such as suicidal ideation, hopelessness, depressive and borderline symptoms. The significantly and consistently larger long-term reduction in self-harm behavior for adolescents having received DBT-A compared with enhanced usual care, however, suggests that DBT-A may be a favorable treatment alternative for adolescents with repetitive self-harming behavior., (© 2019 Association for Child and Adolescent Mental Health.)

Background: Several outcome studies have reported on the short- and long-term effects of migraine in selected clinical samples of children and adolescents. However, current knowledge of the course, incidence, and outcome predictors of frequent headaches in early adolescents in community populations is limited, and little is known about the long-term effects. Headache remains untreated in most of these young people. Here we examined the course, incidence, and outcome predictors of frequent headaches (at least once a week) over the long term (14 years) using previously assessed data at the baseline and 1-year follow-up of early adolescents., Methods: Out of an original sample of 2440 who participated in the first two assessments, a sample of 1266 participants (51.9% response rate) aged 26-28 years (mean = 27.2 years) completed an electronic questionnaire comprising questions about their headache frequency and duration at the long-term follow-up. These headache characteristics together with gender, age, parental divorce, number of friends, school absence, impairment of leisure-time activities and seeing friends, pain comorbidity, and emotional (in particular, depressive symptoms) and behavioral problems were analyzed., Results: In these young people, 8.4% reported frequent headaches (at least once a week) at the extended follow-up, while 19% of the participants having such headaches at baseline again reported such levels with a negligible gender difference. Over the follow-up period, 7.4% had developed frequent headaches, and a higher percentage of females reported such headaches (11.3% in females, 1.5% in males). In a multivariate model, frequent headaches at the baseline, gender (worse prognosis in females), impairment of leisure-time activities and seeing friends, and higher level of depressive symptoms significantly predicted headache frequency at the long-term follow-up., Conclusions: Our findings suggest that gender, greater social impairment, and comorbid depressive symptoms are important indicators for both the short- and long-term prognosis of frequent headaches in early adolescents in community populations.

Adulthood psychiatric and psychosocial outcomes of early adolescence suicidal acts were studied. A representative sample of school adolescents (T1, mean age, 13.7 years; n = 2464; 50.8% female; 88.3% participation) was followed up a year later with the same questionnaire (T2). High scorers of depression were matched with low or moderate scorers and interviewed using the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version (mean age, 14.9 years; n = 345; 94% participation). They were reassessed after 5 years (T3, mean age, 20.0 years; n = 242; 73% participation). Those who attempted suicide before the age of 14 years and repeated suicidal acts between ages 14 and 15 years had worser prognostic profiles than incident cases between ages 14 and 15 years. Male attempters had better psychiatric prognosis than female attempters. Attempters were more likely to have contacted child protection services but not mental health services. Clinicians need to be aware of long-term pervasive outcomes of adolescent suicidality.

Objective: To examine the role of depressive symptoms and disorders as associates and predictors of suicidal acts across adolescence., Method: A representative sample of Norwegian school students (N = 2464, mean age 13.7 years) in grades 8 and 9 was reassessed after one year (T2) with the same questionnaire. All high scorers of depressive symptoms on the Mood and Feelings Questionnaire (MFQ) at T2 were defined as cases. One control from low or middle scorers, matched for age and gender, was randomly assigned to every two cases. This subset (n = 345) was diagnostically assessed by face-to-face K-SADS-PL interviews (mean age = 14.9 years). The same subset was reassessed after 5 years (T3) by using the same questionnaire (n = 252, mean age = 20.0 years) and telephone K-SADS-PL interviews (n = 242). The participation rate was 76.9% (n = 265)., Results: Cognitive symptoms dominated the depressive symptom profile among suicide attempters, irrespective of age and time. Among younger adolescents, suicidal thoughts and acts of self-harm without suicidal intent were associated with suicidal acts. Recurrent thoughts about death, hopelessness, disturbed concentration and middle insomnia were associates of suicidal acts among older adolescents. Worthlessness by 15 years was a significant predictor of suicidal acts between 15 to 20 years. MDD and a depressive episode, not otherwise specified, continued to be significant associates among younger adolescents, while dysthymia by 15 years remained a predictor of suicidal acts between 15 to 20 years, even when controlled for depressive symptoms., Conclusions: Self-harm without suicidal intent, middle insomnia, cognitive depressive symptoms and a formal psychiatric diagnosis of any depressive disorder should alert professionals in the risk assessment of suicidal adolescents.

In a stratified random and representative sample of 2,560 13- to 14-year-old Norwegian girls and boys, depressive symptoms were assessed by means of the Mood and Feelings Questionnaire (MFQ). The MFQ showed a good internal consistency (alpha), and test-retest correlations (r) for three-week and three-month intervals were 0.84 and 0.80 respectively. Convergent and discriminative validity were also assessed. The mean total MFQ score for the whole sample was 10.6 (SD 9.5). The results showed a significant sex by age interaction effect in that girls increased their mean total MFQ sum score by age while the boys' scores decreased slightly. Reports of unattractiveness, restlessness, indecisiveness and transient feelings of low mood were common in the total sample, while unhappiness, irritability, self-dislike and concentration problems were common among high-scoring subjects. Girls experienced more often lowered mood, were more concerned with their appearance and had more self-depreciatory notions than boys, while boys more often than girls had lower school satisfaction. Girls were preponderant among the high-scoring subjects. The results of logistic regression analyses showed that concentration problems were the strongest predictor of high scores. The findings are discussed in view of similar epidemiological studies in which DSM-IV criteria have been used in the assessment of depressive symptoms and disorders among adolescents.