44 HOW TO TREAT : SUICIDALITY IN CHILDREN AND ADOLESCENTS
44 HOW TO TREAT : SUICIDALITY IN CHILDREN AND ADOLESCENTS
14 JULY 2023 ausdoc . com . au
Australian adolescents or young adults who died of suicide having had mental health disorders underscores the importance of treating mental illnesses . 17
A growing body of literature indicates that suicides in adolescents are more likely to be attributable to responses to acute stress than suicides in adults with a strong link to post-traumatic stress disorder . 18-23 Emotion dysregulation , predisposing to poor impulse control , triggered by acute stress and negative peer experience are also critical in adolescent suicide . 24-26
Socio-demographic factors
Suicide is more common in males , while non-fatal suicide attempts are more common among females — with rural residence , poverty and some evidence of the role of migration reported in increasing the suicide risk . 27-39
EPIDEMIOLOGY
THE prevalence rate of suicidal ideation or attempts of children and adolescents vary by geographic region : Germany — suicide attempts 7.6 %, lifetime prevalence 36.6 %; US — lifetime prevalence of suicide ideation 12.1 %, plans 4.0 %, attempts 4.1 %; China — lifetime prevalence male : female for ideation 17.6:23.5 %, plans 8.9-10.7 % and attempts 3.4:4.6 %. 39-41
The second Australian Child and Adolescent Survey of Mental Health and Wellbeing on 41,400 , 12-17 year-olds found that in any 12-month period , the prevalence of suicide attempt was 2.4 %, suicidal ideation 7.5 %, plans 5.2 %, attempts 3.2 % ( 1.3 % multiple attempts ) but only 0.6 % had received treatment . 42 A National Coronial Information System retrospective evaluation found that fewer than one-third had received mental health care at the time of their deaths . 17 These findings suggest that reducing barriers to accessing first-line service providers , such as GPs , needs to be prioritised .
ASSESSMENT AND DIAGNOSIS
YOUNG people presenting with suicidal ideation and behaviour will benefit from a sensitive , caring , non-intrusive and non-judgemental assessment approach . It is also important to consider the developmental capacity of the young person . This includes their understanding of the concept of death and its permanency , as well as their belief system . Those who are not able to verbally express their feelings might benefit from drawing or writing or use of playbased exploration . Assessing the level of comprehension is also important as is taking into consideration the young person ’ s understanding of the lethality or consequences of their behaviour . For example , a young person may take five or 10 tablets of paracetamol thinking that it is enough to cause serious harm , while another may take 50 thinking it will not cause much harm ( see figure 3 ). Additional factors such as cognitive capacity are critical considerations for safety planning . Where necessary , it is important to use simple language and ensure that the young person has understood the safety plan while also involving the parent / carer with detailed instructions and role playing of de-escalation strategies .
It is important to work collaboratively with the family and any other
Schmaal L ., et al . Imaging suicidal thoughts and behaviors : a comprehensive review of 2 decades of neuroimaging studies . Mol Psychiatry
25 , 408 – 427 ; 2020 / CC BY / go . nature . com / 3tSMwL7
Figure 1 . Overview of brain regions evaluated in studies investigating suicidal ideation .
significant people in the young person ’ s life . However , the young person ’ s response style or honesty about the risk severity may be influenced by the presence of family members during assessment . Thus , it is important to give the young person the opportunity to discuss any concerns privately and confidentially . This will need to include any personal , sexual or cultural identity issues and relationship difficulties including social or online issues . Equally , limits of confidentiality and the need to breach confidentiality in situations where the safety of the young person is at risk will need to be discussed . Where relevant , it is important to clarify what information will be shared , under which circumstances and with whom .
Also assess the mental health and physical health , including any medical conditions or medications that are being taken by the patient . Thus , a combination of interviewing the patient and the family / carers separately and together as well as obtaining independent collateral information from school , friends or any other relevant
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These brain regions have been most reported in neuroimaging studies investigating structural , functional , and molecular brain alterations associated with suicidal thoughts and behaviours , with a subset of regions grouped more broadly into ventral prefrontal cortex , dorsal prefrontal cortex , insula , mesial temporal , subcortical , and posterior regions .
DMPFC = dorsomedial prefrontal cortex , dACC = dorsal anterior cingulate cortex , RMPFC = rostromedial prefrontal cortex , mOF- C = medial orbitofrontal cortex , vACC = ventral anterior cingulate cortex , PCC = posterior cingulate cortex , Thal = thalamus , VS = ventral striatum , Hippo = hippocampus ,
Amyg = amygdala , DLPFC = dorsolateral prefrontal cortex , RLPFC = rostrolateral prefrontal cortex , IFG = inferior frontal gyrus , lOFC = lateral orbitofrontal cortex ,
Put = putamen , Caud = caudate .
Database Center for Life Science ( DBCLS )/ CC BY SA / bit . ly / 3wNkQYH
Figure 2 . Prefrontal cortex of left cerebral hemisphere ( shown in red ).
Figure 3 . A young person may take five or 10 tablets of paracetamol thinking that it is enough to cause serious harm , while another may take 50 thinking it will not cause much harm .