Management of Suicidal Behavior in Children and Adolescents

Many therapeutic approaches to managing suicidal behavior among youth have been used, including in-school education programs, screening programs, telephone hotlines, cognitive behavioral therapies, medication management, and inpatient milieux treatment programs. These interventions have been applied based on educational and therapeutic principles drawn from prior work with adolescents in varied scholastic and psychiatric settings. Suicide attempt behavior occurs frequently among adolescents, but the rarity of completed suicide has made it impractical for completion rates to be used as an outcome measure. Treatment research with suicide attempters has examined the predictive validity of screening tools, their adherence to appointment schedules, and admissions to hospital. No treatment program to date, however, has reduced re-attempt rates in adolescent attempters.96 Effective treatments will depend on the collection of more complete data on the psychiatric characteristics of and knowledge of post-attempt events. To create an overview of treatment of adolescent suicide behaviors, this article brings together research from diverse areas related to suicide behavior during adolescence, including risk factors for suicide in adolescents, based on psychological autopsy studies of adolescent completers and characteristics of suicide attempts. Effects of age and of treatment setting, especially inpatient treatment units or emergency rooms, are interpreted. Adolescents differ from adults in coping styles, medical condition, financial status, occupation, social support networks, and types of stressors.96