Suicidality Kids
Reference
Summary of Suicidality in Kids from Aus Doc
Causes
Complex, biopsychosocial model
Protective factors
Early healthcare support, connectedness, self-worth, self-esteem, beliefs against suicide
Biological
Brain regions that subserve emotion and impulse regulation are involved. Ventral and Dorsal Prefrontal Cortex
Psychological
Mental health issues and substance use may predispose. 57% of adolescents and young adults who died of suicide had a mental health issue. Kid suicide most likely acute stress response, adult most likely from PTSD disorders.
Social
More common in poor, rural, men
Prevalence
Suicidal ideation + attempts in kids are highest in Germany at 7%, with a lifetime prevalence of 36%.
Australian data in Adolescents per year - risk of attempt 2.4%, ideation 7.5%, plans 5%, multiple attempts 1.3%
Assessment
Sensitive, caring, non-intrusive, non-judgmental environment
SUICIDE
S = Social Recent loss / separation, setbacks, bully, family stressors, history trauma / abuse, supports
U = Under the Influence Drugs
I = Intent Details, meaning, motivation, leaving notes, goodbyes, method
C = Conduct Disorder May increase risk
I = Impulsitvity Increases risk
D = Depression Most common cause.
E = Ever before Previous ideation increases risk
Depression Screening tool
Management
Self-harm is a spectrum from
Ideation
The non-suicidal self-harm
The suicide attempt
To suicide
Creating and sustaining engagement at assessment and follow-up
Assessment aims to minimise foreseeable risk, diagnosis and treat underlying conditions and mobilises strengths and supports.
The young person is preferably interviewed alone in a quiet, safe and well-provided environment.
Referral
Escalate to services if
High lethality (medically serious) suicide attempt.
Suicide attempt involving preparation, concealment or belief that the attempt would be serious.
Ongoing (pressing) suicidal thoughts, wishes, intentions, plans.
Inability to openly and honestly discuss the suicide attempt.
Inability to discuss safety planning.
History of past suicide attempts.
Escalating suicidal actions.
Lack of alternatives for adequate monitoring and treatment.
Psychiatric disorders (eg, unipolar major depression, bipolar disorder, psychotic disorders, or substance use disorders), underlying suicidal ideation and behaviour.
Agitation.
Impulsivity.
Severe hopelessness.
Poor social support.
Addressing Risk and Safety Planning
Safety planning with the patient
Identify warning signs and triggers of a worsening mental state (eg, social withdrawal)
Restrict access to means; suicide methods can always be found by those determined to use them, but faced by ambivalence about suicide and youth impulsivity and substance-affected mental states, restriction of collaborative methods buys time
Avoid recreational substances as they facilitate impulsivity and/or suicidal behaviours
Consider self-care; coping strategies and healthy activities such as making positive behavioural choices; acceptance of anxiety (self and family)
Key places and people with whom to connect (family, friends, professionals; school, community, emergency professional contacts), including connecting to aftercare programs where possible (eg, the Way Back Support Service of Beyond Blue); peer support workers, brief therapies
Consider reasons for living, values
Attend mental health follow-up early and ensure treatment adherence (medications, appointments)
Safety planning with the patient’s family and friends
Ensure that medications are taken, appointments are made/kept, remove sources of harm, undertake pleasant events, keep routines going, avoid conflict, recognise that a level of anxiety is normal, get help for oneself
Identify effective modes of communication
List emergency professional contacts
Effective Treatments
Psychotherapies are first line for depressive disorders
DBT, teaches mindfullness, distress tolerance, emotional regulation
Attachment-based family therapy, Mentalisation-based therapy, Integrated-CBT
Psychopharmacology
No specific indication for suicide
Prognosis
15-25% of adolescents treated in hospital return within 12 months.
75% of adolescents with BPD are superimposed with suicidal incidents.
Resources:
Beyond Blue:
Suicide Prevention Australia