Abstract
The current study compared the correlations of different types of stressful life events (SLE) between suicidal adolescents with major depressive disorder (MDD) and suicidal adolescents with borderline personality disorder (BPD). Both groups were referred following an attempted suicide. Twenty adolescents with MDD and 20 adolescents with BPD who were consecutively referred to an outpatient clinic following a suicide attempt were evaluated. A community control group of adolescents with no lifetime history of suicidal behavior was also assessed. The following measurements were employed: the Suicide Risk Scale (SRS) Beck Depression Inventory (BDI), the Life Events Checklist (LEC), and the Childhood Sexual Abuse Questionnaire (CSEQ). Both groups of suicidal subjects reported more SLE in general and more physical abuse than community controls in the 12 months before the suicide attempt. The MDD adolescents had more lifetime death-related SLE than the BPD and control groups, while the BPD adolescents reported more lifetime sex abuse-related SLE than the other two groups. Thus, suicidal behavior in general may be related to the amount of SLE. However, different disease-specific life events may precipitate suicide attempts in adolescents with MDD and BPD.
Results
On analysis of variance (ANOVA) [F(2, 57) = 474.53, P < .001], the BDI significantly differentiated between the MDD group (52.91 ± 5.64), the BPD group (12.33 ± 4.58), and the controls (4.04 ± 6.09). A post hoc Scheffé test showed that the MDD group was higher than the BPD group (P < .05), which in turn was significantly higher than the control group (P < .05).
On ANOVA, SRS significantly distinguished between the groups [F(2, 57) = 366.21, P < .001] The SRS scores were not significantly different for MDD and BPD subjects (12.86 ± 1.17 and 12.56 ± 1.10, respectively), which were significantly higher than for the controls (1.45 ± 2.09) on the Scheffé post hoc analysis.
Comparison of both the suicidal patients with normal controls for number of SLE showed a nonsignificant difference between any of the groups. Suicidal subjects had a mean of 12.15 ± 4.14 SLE and controls 14.10 ± 8.54 (t = 0.97, P > .05). Results for negative SLE were significant: 10.73 ± 3.90 and 6.60 ± 5.86 for suicidal subjects and controls, respectively (t = 2.78, P < .05). There was no significant difference between the suicidal MDD and the suicidal BPD adolescents.
Comparison of the suicidal patients with normal controls for number of SLE in the 12 months before the suicide attempt showed a significant difference for both total SLE and negative SLE. Suicidal subjects had a mean of 7.84 ± 3.14 SLE and controls 4.84 ± 3.52 (t = 2.86, P < .01). Results for negative SLE were 7.05 ± 3.24 and 4.33 ± 3.42 for suicidal subjects and controls, respectively (t = 2.78, P < .05). There was no significant difference between the suicidal MDD and the suicidal BPD adolescents.
The number of deaths of a first-degree relative during the subject’s lifetime was compared between the three groups. The means of the MDD, BPD, and control subjects were 0.86 ± 0.56, 0.17 ± 0.38, and 0.45 ± 0.76, respectively. ANOVA showed [F(2, 57) = 7.03, P < .001]. A post hoc Scheffé analysis showed that MDD subjects had experienced significantly more deaths of a first-degree relative than both the BPD and control groups (P < .05). The latter two groups did not differ significantly on this variable (Table 1). There was, however, no significant difference for lifetime loss events in the broad sense (deaths of or separation from relatives or friends) among the three groups, although the depressed group had higher values than the other two groups (Table 1). There were not enough death-related events in the year preceding the attempt to warrant analysis.
Table 1.
Comparison of the Number of Lifetime Specific Stressful Life Events Between Adolescents With Major Depression, Borderline Personality Disorders, and Normal Controls
Specific Life Event Major Depression (n = 20) Borderline Personality Disorder (n = 20) Controls (n = 20) F (2, 57)
Deaths (of first-degree relatives) 0.86 ± 0.56a 0.17 ± 0.38b 0.45 ± 0.76b 7.03∗
Losses (of other relatives, friends; separations) 4.73 ± 2.35a 4.33 ± 1.82a 4.40 ± 4.24a 0.98
Sex abuse 0.05 ± 0.21a 0.94 ± 0.11b 0.05 ± 0.22a 12.64∗
NOTE. Different superscripts mean significant difference on post hoc Scheffé test after ANOVA.
∗
P < .001.
Table options
The number of sexual abuse incidents in childhood was then compared among the three groups. The means of the MDD, BPD, and control groups were 0.05 ± 0.21, 0.94 ± 0.11, and 0.05 ± 0.22, respectively. ANOVA showed [F(2, 57) = 12.64, P < .001]. A post hoc Scheffé analysis showed that the BPD subjects had experienced significantly more sexual abuse events than both the MDD and control groups (P < .05). The latter two groups did not differ significantly on this variable. The distribution of the number of events is shown in Table 2. There were not enough sex abuse-related events in the year preceding the attempt to warrant analysis
Table 2.
Distribution of the Number of Sexual Abuse Events Between Suicidal Depressed, Suicidal Borderline, and Normal Control Adolescents
No. of Sexual Abuse Events
None 1 2 3 4
MDD 19 (95) 1 (5) 0 0 0
BPD 8 (40) 6 (30) 5 (25) 0 1 (5)
Controls 19 (95) 1 (5) 0 0 0
NOTE. Percentages in parentheses.
Table options
Twenty-four of the 40 suicidal adolescents reported having experienced lifetime physical abuse as children. In most cases, this was in the form of beatings by the parents or stepparents (usually the father). This was a significant difference from the control group where none of the subjects reported physical abuse (Cramer’s V = 0.58, P < .001). There was no significant difference in the proportion of MDD subjects (50%) versus the BPD subjects (30%) who underwent abuse (Z = 1.43, P > .05). There were not enough physical abuse incidents in the year preceding the suicide attempt to warrant a separate analysis.
