NEW ORLEANS -- Adolescents who attempt suicide often characterize themselves as isolated, unloved or unlovable, and living under unbearable stress.
These teens often have a black-and-white outlook on acceptable behavior, and when they engage in what they consider unacceptable behavior, they try to punish themselves for that transgression.
A very high percentage of these kids also have experienced a significant object loss before the attempt, Dr. Vincent Collins said at the annual meeting of the American Academy of Pediatrics. "They may have lost a pet, a sibling, a parent, or a grandparent, and they nourish a fantasy about reuniting with the lost object after death."
The presence of a psychiatric illness is a very strong risk factor for suicide attempt, said Dr. Collins, chief of psychiatry at Children's Hospital, Columbus, Ohio. Unfortunately, the illness often goes undiagnosed until it's too late; 90% of successful suicides met the diagnostic criteria for a mental illness, but only 50% had been diagnosed before the suicide.
Bipolarity carries the highest risk of suicidal ideation and attempt, with 25%-50% of bipolar teens attempting suicide at least once. Depression has a weaker link; only 10%-20% of those with clinical depression will attempt suicide.
"There are plenty of depressed kids who would never think of suicide and conversely, there are plenty of suicidal kids who don't meet the diagnostic criteria for depression," said Dr. Collins.
All of the anxiety disorders, except for obsessive-compulsive disorder, are associated with an increased risk of suicide attempt, he said. This seems to be linked to the constant stress of living with the symptoms. "My patients tell me that to be subjected to constant panic attacks and anxiety is excruciatingly painful, so to these people, death begins to look like a viable alternative."
Suicidal ideation among adolescents with a medical condition remains surprisingly low.
"These kids struggle on a daily basis with chronic pain, disfigurement, decreased independence, diminished ability to engage in group activities, and even the threat of death, yet there is no increase in suicidal thought or behavior," he said.
The only medical conditions that do pose an increased risk are those that involve the central nervous system, like multiple sclerosis. This may speak to a possible link between dysregulation of the serotonin transport system and suicidal ideation, Dr. Collins said.
When assessing a teen who has attempted suicide, it's important to be in a safe, controlled setting. The emergency department, where most suicide attempters are first seen, isn't the right place.
"If it's feasible to do the interview in a quiet, secluded area, you'd be well advised to do so," Dr. …