N E W RE S E A R C H P O S T E R S

4.52 — 4.55

behavior, 44 of whom also exhibited suicidal ideation. Adolescents with cut- 4.53 PRECIPITATING CIRCUMSTANCES OF
ting behavior were hypothesized to demonstrate increased suicide risk, SUICIDE IN YOUTH WITH A DEPRESSED MOOD
mood, or personality disorder diagnoses and longer inpatient stays.
Paige Schlagbaum, BS, Nationwide Children’s Hospital,
Results: Relative to adolescents without cutting behavior, adolescents with
cutting were significantly more likely to present with suicidal ideation (c2 ¼
[email protected]; Donna
11.33, p ¼ 0.001), a suicide plan (c2 ¼ 18.40, p < 0.001), and a suicide attempt A. Ruch, PhD; Arielle H. Sheftall, PhD; Jaclyn
(c2 ¼ 4.31, p ¼ 0.038). Adolescents with cutting were notably older (t ¼ 4.50, L. Tissue, LISW-S, LCDCIII; Jeffrey A. Bridge, PhD
p < 0.001), more likely to be female (c2 ¼ 29.68, p < 0.001), more likely to be Objectives: Suicide is the second leading cause of death among youth ages
diagnosed with a primary mood disorder (c2 ¼ 4.86, p ¼ 0.032) and less likely 10–19 years, thus claiming the lives of 2553 in 2016. Suicide rates have
to be diagnosed with a primary psychotic disorder (c2 ¼ 5.60, p ¼ 0.018). increased by 48% in the past decade. Depressed mood is commonly
Contrary to expectations, adolescents with cutting had significantly shorter expressed as a warning sign and risk factor of suicide in youth and adults. The
stays on CAPE (t ¼ 2.02, p ¼ 0.04). Compared with adolescents who exhibited following study examined precipitating circumstances of suicide associated
cutting behavior only, those who presented with both cutting and suicidal with depressed mood at time of death in youth suicide decedents.
ideation were significantly more likely to be female (c2 ¼ 13.02, p < 0.001) and Methods: Data from the National Violent Death Reporting System (NVDRS)
receive a primary diagnosis of a personality disorder (c2 ¼ 8.65, p ¼ 0.013). surveillance database were analyzed for 17 US states from 2003 to 2012.
Conclusions: The present study affirms the role of cutting as a risk factor Participants included all suicide decedents aged 10–19 years (N ¼ 4032).
associated with suicidality and identifies several demographic and clinical Analyses were stratified by sex, and logistic regression compared youth sui-
factors that differentiate adolescents with and without cutting. These factors cide decedents with documented depressed mood at time of death with
can aid emergency care providers to make decisions regarding patient care. those who had no report of recent depressed mood.
Results: Among both males and females, youth with documented depressed
SIB, S, ICP
mood before death by suicide were more likely to have recently disclosed their
https://doi.org/10.1016/j.jaac.2018.09.277
suicidal intent, have a history of suicide attempt, and engage in current and past
mental health treatment. Youth with depressed mood were also more likely to
have a crisis within 2 weeks of death, to have problems with intimate partners
and school, and to have experienced a recent death of a friend or family
4.52 CHANGES IN COGNITIVE FUNCTION AFTER member. Sex specific differences in youth with depressed mood included bi-
TREATMENT WITH DBT OR SUPPORTIVE polar disorder diagnosis in females; older age and drug- and alcohol-related
problems, and physical health, job, and financial problems in males.
THERAPY FOR SUICIDAL ADOLESCENTS Conclusions: Youth suicide decedents with documented depressed mood at
Pilar Santamarina-Perez, PhD, Institute of Neuroscience, time of death were more likely to display known risk factors and precipitating
University of Barcelona, [email protected]; circumstances of suicide, including disclosure of suicidal intent and history of
Iria Mendez, MD; Marisol Picado, PhD; Francisco suicide attempt, as well as engage in current and past mental health treatment
Jose Eiroa, PhD; Elena Font, PsyD; Elena Moreno, PsyD; compared with youth with no reports of depressed mood. These findings
Esteve Martinez, PsyD; Astrid Morer Linan, MD, PhD; highlight the importance of educating families, peers, and pediatric mental
Carlos Cordovilla, MD; Soledad Romero, PhD health care providers on how to recognize and respond to the warning signs of
suicide and to treat all disclosures of suicidal thoughts and behaviors seriously.
Objectives: Impaired cognitive function is a feature of suicidal behavior. It also
might be considered a risk factor in adolescents with high vulnerability to ADOL, S, DDD
commit suicide. Previous studies have suggested that some aspects of cognitive https://doi.org/10.1016/j.jaac.2018.09.279
function improve after psychological treatment. However, to our knowledge,
there are no studies that have evaluated the influence of psychological treat-
ment on cognitive functioning in adolescents with suicidal behavior. The aim of 4.55 THE INTERPERSONAL THEORY OF SUICIDE
this study was to examine changes on neuropsychological functioning in ado-
lescents with suicidal behavior following a psychological treatment with DBT and AND TRANSGENDER TEEN SUICIDALITY:
supportive therapy (ST) compared with healthy control subjects. CLINICAL REPORTS AND SYSTEMATIC REVIEW
Methods: A total of 35 adolescents with self-harming behavior and 17 healthy Ramkrishna D. Makani, MD, MPH, Children’s Hospital of
control subjects between 12 and 18 years of age completed neuropsycho- Philadelphia, [email protected]; Ellen
logical testing at baseline and after 16 weeks. The neuropsychological battery H. Sholevar, MD
consisted of the following: 1) Wechsler Intelligence Scale for Children-Fourth
Objectives: Rates of suicidal ideation and suicide attempts have increased 2- to
Edition (WISC-IV); 2) Spain-Complutense Verbal Learning Test; 3) Rey Com-
4-fold in transgender youth compared with cisgender youth in the last 2 de-
plex Figure Test; 4) Trail Making Test; 5) Stroop Effect Test; 6) Controlled Oral
cades. Literature on the theoretical understanding of the etiology of suicidality
Word Association Test (COWAT); and 7) Tower of London test. Patients were
among gender minorities has expanded recently. The interpersonal theory of
randomized after baseline assessment into 2 psychological groups: DBT
suicide has received consideration and is applicable to this population. This
and ST.
abstract consists of a case report to conceptualize a transgender youth’s suicide
Results: t tests were used for baseline comparisons between suicidal adolescents
attempt using the interpersonal theory of suicide and systematic review.
and control groups, and between repeated measure analyses of variance for the
Methods: This systematic review was conducted using PubMed, PsycINFO
difference in change between the suicidal adolescents and control groups from
from 1996 to January 2018. A total of 78 articles were retrieved in addition to
baseline and follow-up, for all neuropsychological scores. Significant neuropsy-
the case report.
chological impairment was evident at baseline in suicidal participants compared
Results: Among the 78 articles, 17 articles were relevant and selected, which
with healthy control subjects. After 16 weeks of psychotherapy, neuropsycholog-
revealed that 45–77% of transgender youth had suicidal ideation and 28–52%
ical scores showed significant improvement regardless of the type of therapy. We
had made one or more suicide attempts. Contributing factors include
found effect sizes between 0.10 and 0.18 in intelligence index (verbal compre-
thwarted belongingness, exemplified in this case by rejection of transgender
hension, perceptual reasoning, and processing speed), in verbal memory (delayed
status by family, friends, and community, leading to social isolation and
recall and recognition), and in executive functioning (Tower of London-total time).
loneliness. Another factor was perceived burdensomeness associated with
Conclusions: These results suggest that both DBT and ST might improve some
self-hatred and the sense of being a liability to others. Lastly, the individual
cognitive functions associated with adolescents with suicidal behavior. Addi-
must “lose fear associated with suicide” with increased physical pain toler-
tional studies with larger sample groups are needed to confirm these results.
ance before moving toward an act of suicide. Feelings of perceived bur-
COG, S, TREAT densomeness alone are more highly correlated with increased suicidal
Supported by the Fundaci
on Alicia Koplowitz ideation than thwarted belongingness. Together, along with decreased fear
https://doi.org/10.1016/j.jaac.2018.09.278 of suicide and increased pain tolerance, the youth was at high risk for suicide.

Journal of the American Academy of Child & Adolescent Psychiatry www.jaacap.org S221
Volume 57 / Number 10S / October 2018
Descargado para Anonymous User (n/a) en Antenor Orrego Private University de ClinicalKey.es por Elsevier en mayo 26, 2020.
Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2020. Elsevier Inc. Todos los derechos reservados.
 N E W RE S E A R C H PO S T E R S
4.56 — 4.58

The case presented involves a 16-year-old depressed transgender youth who Objectives: To improve the mental health referral process for children
made a serious suicide attempt. The interpersonal theory of suicide assisted in referred by primary care providers (PCPs) to Community Mental Health Clinics
the understanding of the etiology of this youth’s suicide attempt. (CMHCs) using a community-partnered approach.
Conclusions: Despite the increased suicidal problems in transgender youth, Methods: Our partners were a multi-site federally qualified health center
limited research has contributed to the theoretical understanding and the (FQHC) and 2 CMHCs in Los Angeles County. We randomized 6 FQHC clinics
ability of clinicians to accurately assess the risk of suicide in this population. and implemented a newly-developed telehealth-based referral process at
Future research should focus on the development of clinical interventions intervention clinics utilizing a live videoconference CMHC screening with a
targeting the linkage of thwarted belongingness, perceived burdensomeness, telehealth care coordinator for all mental health referrals. Our primary
and acquired capability of self-harm. The troubling use of “conversion ther- outcome was completion of the CMHC screening visit, the access point for
apy” in this population should also be addressed. referral to specialty mental health care, either in person/phone, or via
LGBT, S, ADOL videoconference. We used mixed-effects regression model (with random ef-
https://doi.org/10.1016/j.jaac.2018.09.280
fects for clinic) to examine intervention impact on our primary outcome; we
adjusted for child’s age, sex, household annual income, parent’s highest
educational attainment, parental employment, Pediatric Symptom Checklist
(PSC) score, child and parent overall health, and parental depression.
4.56 EXPLORING COUNTERTRANSFERENCE Results: Overall, 342 parents with a child age 5-12 were enrolled and
THROUGH FILM completed a baseline survey. For secondary outcomes, 289 parents (85%)
Cynthia M. Carter, MD, University of Texas Health Science completed the 6-month assessment. At baseline, participants at intervention
Center, [email protected]; Tracee Ridley-Pryor, ARNP, and control clinics had similar characteristics, except that parents in the
University of Texas Health Science Center, tracee.ridley- control group were more likely to be unemployed (61.8% vs. 42.7 %); and
[email protected]; Danielle C. Whitehurst, MD; Valerie more intervention parents (19.2%) than control parents (10.7%) reported an
annual income of $35,000. Adjusted analysis indicated that children in the
K. Arnold, MD; Maruf Sarwar, BS; Lindi Berkey, BS
intervention group were more likely to complete the initial CMHC screening
Objectives: Countertransference refers to the totality of a provider’s visit compared with control, by chart review at the CMHC (80.49% vs. 64.04%;
emotional response to a patient. It is usually discussed in the context of AOR 3.17 [95% CI 1.46, 6.91]).The number of days between referral and the
psychotherapy; however, all medical providers who interact with patients are initial access screening visit was greater for intervention families (mean 23.6
subject to emotional responses, which can potentially affect patient care. This days) than control families (17.1 days). Intervention group participants were
study explores the extent to which mental health providers and providers in more likely to report family-centered care (86.3 % vs. 75.3 %) but this differ-
nonmental health specialties are aware of countertransference and the ways it ence was not statistically significant (p¼0.08). Intervention group parents re-
potentially affects their work and to observe whether watching a film can ported higher satisfaction with the referral system and with care overall.
affect beliefs and awareness of countertransference. Quality of life did not vary by intervention status at 6 month follow-up.
Methods: Surveys were obtained from a group of 20 medical providers who Conclusions: A novel telehealth-coordinated referral process using a com-
specialize in mental health (n ¼ 11) or nonmental health specialties (n ¼ 9) who munity-partnered approach improved initial access to CMHCs for children
attended the 11th Annual Family Medicine/Psychiatry CME conference, referred by primary care.
before and after viewing a film with strong elements of countertransference
and participating in a discussion. R, TVM, SP
Supported by Patient-Centered Outcomes Research Institute Grant IH-12-11-
Results: There were notable differences between the responses and change in
4168-IC
responses from prefilm to postfilm between those who work in mental health versus
https://doi.org/10.1016/j.jaac.2018.09.282
other specialties. Those who work in mental health were more likely to be familiar
with the term countertransference (100% of mental health workers vs 55% of
nonmental health workers) or to have noticed having experienced countertrans-
ference toward a patient in the past. Mental health workers were also much more 4.58 TRENDS IN PSYCHIATRIC SEASONAL
likely to agree that having negative or positive feelings toward a patient is EMERGENCY ADMISSION (TIPSEA)
acceptable as long as those feelings do not affect their work. After the film and Ali Eslami, MD, PhD, University of British Columbia,
discussion, however, there was an increase in nonmental health workers agreement [email protected]; Sinead Nugent, MSC; Ryan Yan, BS;
with this statement. After the film and discussion, both groups were more likely to Samiaa Rahman, BS; Vicky Matthews, BS; S.
agree that a provider’s emotional response to a patient adds to therapeutic alliance.
Evelyn Stewart, MD
Conclusions: Awareness of countertransference was less common among
nonmental health providers, which is expected as this concept is typically Objectives: Understanding trends in pediatric emergency department (ED)
taught in the context of mental health. By watching a film with strong ele- admissions is important because the number of presentations for mental
ments of countertransference and participating in a discussion, awareness and health crises is the fastest growing segment of pediatric ED visits. Patients
opinions about countertransference changed. This film and discussion format who are primarily suffering from internalizing disorders are highly vulnerable
may be a fun and effective method of expanding knowledge of such concepts to stress. Therefore, school year, compared with summertime as a result of
among medical providers. perceived academic and peer pressure, could increase potential short-term
presentations in the ED. Summertime could be challenging because care-
OTH givers may struggle to maintain routines and structures, typically necessary for
Supported by the AACAP/Assembly Advocacy and Collaboration Grant
management of patients with externalizing disorders, which could result in
https://doi.org/10.1016/j.jaac.2018.09.281
more emergency presentations during summer breaks.
Methods: We examined a retrospective cohort of 1776 admissions (55.6% female,
mean age ¼ 13.66, SD ¼ 2.48) to the Child and Adolescent Psychiatric Emergency
4.57 IMPROVED ACCESS TO MENTAL HEALTH Unit at BC Children’s Hospital (January 1, 2009–December 15, 2014). We reviewed
CARE USING A TELEHEALTH-ENHANCED medical records for demographics, primary mental illness diagnoses, and reasons
REFERRAL PROCESS IN PEDIATRIC PRIMARY for admission. Chi-square statistics used to compare internalizing versus exter-
nalizing disorders during vacation periods versus school year.
CARE: A CLUSTER RANDOMIZED TRIAL
Results: Overall, there were significantly more female than male admissions (c2
Tumaini R. Coker, MD, MBA, Seattle Children’s Hospital, ¼ 27.82, p < 0.0001) and more admissions because of internalizing versus
[email protected]; Lorena Porras- externalizing disorders (c2 ¼ 74.77, p < 0.0001). However, when comparing ad-
Javier, MPH; Lily Zhang, MS; Neelkamal Soares, MD; missions during academic year versus vacation period (summer, winter, and
Christine Park, MD, MPH; Alpa Patel, MD; Lingqi Tang, PhD; spring breaks combined), a significant interaction was found for admissions
Paul Chung, MD, MS; Bonnie T. Zima, MD, MPH because of externalizing disorders during summer time (c2 ¼ 10.23, p < 0.002)

S222 www.jaacap.org Journal of the American Academy of Child & Adolescent Psychiatry
Volume 57 / Number 10S / October 2018
Descargado para Anonymous User (n/a) en Antenor Orrego Private University de ClinicalKey.es por Elsevier en mayo 26, 2020.
Para uso personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2020. Elsevier Inc. Todos los derechos reservados.