Study identifies measures to assess risk of suicidal behavior in children and adolescents

Nearly 37,000 people died by suicide in the United States in 2009. Suicide was the tenth leading cause of death overall and the third leading cause of death for young persons ages 15 to 24 years, after accidents and homicide.

"Youth die by their own hands," says Timothy W. Lineberry, M.D., of the Department of Psychiatry and Psychology at Mayo Clinic in Rochester, Minn. "The impact of suicide and suicide attempts in child and adolescent populations is incalculable, yet there is a relative paucity of measures for assessing suicide risk. It's important to gain information about how to manage that risk and to target interventions." On May 8, Dr. Lineberry presented the results of new research in the workshop "Assessment of Suicidal Behavior in Children and Adolescents" at the American Psychiatric Association 2012 annual meeting in Philadelphia, Pa.

Dr. Lineberry's team first reviewed all available literature related to findings at Mayo Clinic and elsewhere. Of 401 publications evaluated, 17 met the study's parameters for inclusion.

The team reported separate findings from clinical research using a structured assessment form previously validated in inpatient care, the Suicide Status Form (Jobes et al), to identify differences between how boys and girls look at suicide and suicide attempts and to clinically endorse those differences. "Boys and girls look at associations and factors such as hopelessness, anxiety and self-hate — how they feel about themselves — very differently," says Dr. Lineberry. "If we want to intervene for kids, we need to know what factors play a role in their suicidal thoughts and attempts."

Dr. Lineberry's team found that individual children and adolescents often do a better job of assessing their risk of suicide than their care providers do. "Assessments should integrate feedback from the patient and parents, as well as the physician," says Dr. Lineberry. Yet, boys who committed suicide in 2009 outnumbered girls 3.7 to 1. Research reflects that many boys may not endorse being suicidal.

No one cause of suicide, no one type of suicidal person

"Suicide requires multiple things to go wrong at the same time," says study co-investigator Kathryn (Kate) M. Schak, M.D., of the Department of Psychiatry and Psychology at Mayo Clinic in Minnesota. "Biological factors such as familial risk, predisposing factors such as major psychiatric syndromes, proximal factors such as feelings of hopelessness, and immediate triggers such as public humiliation and shame must all work in concert."

This study confirms the lack of information about high-risk groups and the lack of guidance for evidence-based assessment. It identifies clinical challenges in particular populations. Study results also indicate that a standardized assessment tool, integrated into treatment consistently, will help provide insight to the factors that motivate boys and girls to attempt suicide.