Suicidal Behaviour in Children and Adolescents. Part 2: Treatment and Prevention

Article excerpt

ABSTRACT

Objective: To systematically review the treatment of suicidal behaviour in children and adolescents.

Method: After discussing the principles of treatment, we review the literature regarding adequate assessment, hospital-based services and their alternatives, and follow-up.

Results: Treatment modalities (including psychotherapy) and preventive strategies (including school-based interventions, gatekeeper and primary practitioner training, and treatment of psychiatric disorders) are considered in the light of existing evidence.

Conclusions: The assessment of youth at risk for suicide should include attention to well-established risk factors, but prediction of risk remains difficult. Treatment of suicidal children and adolescents should be evidence-based and may include psychotherapy and psychopharmacology. Effective methods of prevention are emerging, but more research is needed.

RÉSUMÉ

Objectif : Mener une revue systématique du traitement du comportement suicidaire chez les enfants et les adolescents.

Méthode : Après un examen des principes du traitement, nous passons en revue la documentation concernant l'évaluation adéquate, les services en milieu hospitalier et les solutions de rechange, et le suivi.

Résultats : Les modes de traitement (y compris la psychothérapie) et les stratégies préventives (dont les interventions en milieu scolaire, la formation d'observateurs et de médecins des soins primaires, et le traitement des troubles psychiatriques) sont considérés à la lumière des données probantes existantes.

Conclusions : Lors de l'évaluation des jeunes à risque de suicide, on devrait prêter attention aux facteurs de risque bien établis, mais la prédiction du risque demeure difficile. Le traitement des enfants et des adolescents suicidaires devrait être fondé sur des données probantes et peut comprendre la psychothérapie et la psychopharmacologie. Des méthodes de prévention efficaces voient le jour, mais il faut plus de recherche.

(Can J Psychiatry 2007:52[6 Suppl 1]:35S-45S)

Key Words: child, adolescent, suicide, assessment, treatment, prevention

This paper is Part 2 of a review of the literature on suicide in children and adolescents and discusses assessment, management, and prevention of suicidal behaviour in this group. The methodology is reviewed in Part 1.

Principles of Treatment

A continuum of services including emergency intervention and outpatient, home-based, day, and inpatient treatment is necessary for the treatment of children and adolescents with suicidal behaviour. Rotheram-Borus and colleagues found that almost one-quarter of all suicide attempts occurred within 1 month of seeking services, which stressed the importance of screening for suicidality at intake to programs.' Ironically, however, once patients are identified, it is unknown whether specific treatment approaches will prove effective, both within specific diagnostic entities and across the diverse range within which suicidal adolescents present.2 When a treatment plan is instituted, it should address the psychopathology that places the individual at risk.3

Assessment

The suicidal child or adolescent who presents to the emergency department requires a thorough psychosocial assessment and mental status examination. This assessment can be completed by an emergency department physician, psychiatrist, specialized nurse, or social worker, provided they are trained in the assessment of children and youth with mental health difficulties.4,5 Training of emergency staff is important because psychosocial assessments completed by nonspecialist doctors in emergency departments tend to be of variable quality.6 The use of screening tools may be helpful for staff in the emergency department. Horowitz and colleagues developed a 4-item screening tool that included current suicidal behaviour, past suicidal ideation, past self-destructive behaviour, and current stressors and was administered by triage nurses. …