Suicide in the pediatric population: screening, risk assessment and treatment

Abstract

The number of children and adolescents dying by suicide is increasing over time. Patterns for who is at risk are also changing, leading to a need to review clinical suicide prevention progress and identify limitations with existing practices and research that can help us further address this growing problem. This paper aims to synthesise the literature on paediatric suicide screening, risk assessment and treatment to inform clinical practice and suicide prevention efforts. Our review shows that universal screening is strongly recommended, feasible and acceptable, and that there are screening tools that have been validated with youth. However, screening may not accurately identify those at risk of dying due to the relative rarity of suicide death and the associated research and clinical challenges in studying such a rare event and predicting future behaviour. Similarly, while risk assessments have been developed and tested in some populations, there is limited research on their validity and challenges with their implementation. Several promising suicidespecific treatments have been developed for youth, but overall there is an insufficient number of randomised trials. Despite great need, the research evidence to support screening, risk assessment and treatment is still limited. As suicide rates increase for children and adolescents, continued research in all three domains is needed to reverse this trend.

Neurobiological Basis of Increased Risk for Suicidal Behaviour

“…It is beneficial in the pediatric population [111]. Psychological interventions focus on strengthening skills in interpersonal communication, stress tolerance, and emotion regulation [45,117].…”

Sexual Minority Status and Age of Onset of Adolescent Suicide Ideation and Behavior

“…[29][30][31] Current recommendations from the US Preventive Services Task Force and the American Academy of Pediatrics promote universal screening for depression after age 12 years. 32,33 Although there are unique challenges associated with the implementation of pediatric suicide risk screening, 34 a growing number of brief screening tools have been developed to detect suicide risk in youth. [35][36][37] Regardless of whether suicidality is detected within or outside the context of depression, an improved understanding of the timing of sexual minority disparities in suicide ideation and behaviors could inform the appropriate age at which suicide risk screening procedures should incorporate an assessment of sexual orientation to enhance clinical care.…”

Suicidal ideation and executive functioning in pediatric cancer

“…have not yet been examined. 41,42 However, our results suggest that interview-based evaluations or multi-informant examinations may be needed, due to the discrepancies between parent-, child-, and teacher-report of suicidal ideation among survivors.…”

“…Broadband measures of psychosocial risk specific to families affected by pediatric cancer do exist for routine use, and recent additions to these measures, such as the Psychosocial Assessment Tool, include risk items related to suicidality 40 . Other suicidality screening tools are also validated for children and adolescents, yet differences in administration methods (e.g., self‐report, provider‐administered) have not yet been examined 41,42 . However, our results suggest that interview‐based evaluations or multi‐informant examinations may be needed, due to the discrepancies between parent‐, child‐, and teacher‐report of suicidal ideation among survivors.…”