Malady Wise

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Suicidality Kids

Maladywise

Reference

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