Editors

MauriMarttunen

Risk of Suicide in Adolescence

Suicidal thoughts and attempted and completed suicides are rare in childhood but the incidence increases during adolescence.
An earlier attempted suicide and self-destructive behaviour, even if it would not be associated with a wish to die (like cutting) are important risk factor for a reattempted or committed suicide.
Structured assessment methods are useful aids when assessing self-destructive behaviour in an adolescent.
A safety plan should be developed for a clearly self-destructive adolescent.

The annual prevalence of suicidal thoughts among adolescents is approximately 10-15%, and that of attempted suicides at least 4-5%.
Suicidal thoughts and attempts are more common among girls, but about 70-80% of all suicides are committed by boys.
About half of adolescents who have attempted suicide will later make an another attempt.

One in three has previously attempted suicide.
About 60% of adolescents who commit suicide had talked to someone about their suicidal thoughts, often, however, only to their peers.
Psychiatric disorders precede suicide in about 90% of the cases, mood disorder in at least half of the cases.
At least one quarter have suffered from serious substance abuse.
Common precipitants to suicide and suicide attempts are failure, disappointment, a break-up of a relationship or an argument with someone close. Conflicts in family relations, domestic violence and arguments with the parents are also common.

Suicidal behaviour in adolescence is often associated with current psychosocial problems, such as arguments, bereavement and disappointment.
Mood disorders, serious substance abuse and, particularly among males, antisocial behaviour is common.

Self-destructive behaviour in adolescence is strongly associated with depression and substance abuse.
When depression is suspected in an adolescent, suicidal thoughts and suicide attempts should always be broached.
Assess current living circumstances and family situation always if an adolescent expresses suicidal thoughts or intents.
Evaluate the type and severity of associated psychiatric disorder and/or substance abuse.
Ask whether the patient has attempted suicide or harmed him-/herself in some other way in the past.
Assess whether the patient really wants to die, has he/she made suicidal plans or arrangements.
The use of structured assessment forms, such as the C-SSRS (Columbia Suicide Severity Rating Scale http://cssrs.columbia.edu/), improves the assessment of the risk for immediate self-destructive behaviour.

Always agree on follow-up appointments and encourage the patient to carry on with the treatment.
Facilitate easy access to treatment.
Meet the young person's parents as well and assess whether the family is able to sufficiently support the patient.
Develop a safety plan for the young person together with him/her and the parents.
If necessary, contact the child protection services in order to arrange support for the family.
If self-destructiveness is associated with depression, its treatment should be instigated without delay.
Of the selective serotonin reuptake inhibitors (SSRIs), fluoxetine is the first choice in the psychopharmacological treatment of a self-destructive adolescent with major depression Depression in Adolescents.
Always refer an adolescent who has attempted suicide for psychiatric consultation, the quicker the better.
Psychiatric hospitalization should be considered Factors Associated with Suicide after Parasuicide in Young People if the suicidal adolescent suffers from
- psychotic disorder
- major depression
- bipolar disorder
- severe aggressive behaviour
- severe substance abuse or dependence
- if care in the community after a previous suicidal episode has failed.
Hospitalization is also justified after a serious suicide attempt (high lethality or high suicidal intent), if the adolescent's suicidal thoughts do not subside, and if the adolescent's family cannot offer sufficient support.

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