PSYCHIATRIC INTERVIEW SHOULD ADDRESS THE FOLLOWING: |
Acute stressors (e.g., romantic break up, school failure) |
Recurrent thoughts of past stress, abuse, or trauma |
Substance abuse, psychosis, and other diagnoses, in addition to depression |
Self-injurious behavior, associated thoughts, reasons for self harm (coping strategy vs. wish to die) |
Frequency and duration and intensity of suicidal thoughts |
Suicidal intent, plans, and access to lethal implements or drugs |
History of suicide attempts |
Family history of suicide and friends who have died |
Availability of interpersonal resources and support |
ASSESSMENT APPROACH |
Use a calm, nonjudgmental approach |
Be firm about need to establish safety |
Spend at least part of the interview with the teen alone |
Obtain collateral information from parents/family, therapist, caseworkers, and others |
Conduct physical exam and consider routine labs and urine toxicology screen |
SUICIDE RISK FACTORS: |
Diagnoses: major depressive disorder, substance abuse, conduct disorder, and psychotic disorders |
Demographics: older teens attempt and complete suicide more often; females have more attempts, but males complete suicide more often and use more lethal means |
Recent life events: academic or legal problems, recent loss of family, friends |
Sexuality issues: break up of romance, gender identity conflicts |
Past life events: youth history of attempts, family suicide, history of physical or sexual abuse |
Interpersonal: poor family communication, lack of peer support |
Environmental: access to lethal means, exposure to suicide in the community or media |
INPATIENT TREATMENT IS RECOMMENDED WITH THE FOLLOWING: |
Persistent and/or intense thoughts of suicide |
Specific suicidal plans or previous suicide attempts |
History of impulsive and dangerous behaviors |
Severe depression, psychosis (especially with command hallucinations), and/or substance abuse |
Inability to specify plans to support safety |
Lack of adequate support from family and/or friends |
OUTPATIENT TREATMENT MAY BE CONSIDERED WITH THE FOLLOWING: |
Transient or fleeting thoughts of suicide, but none currently |
Ability of youth to articulate reasons to live |
Secure environment that limits access to lethal means, especially firearms |
Parental awareness of contributing risks including substance use |
Youth, family, and clinician agreement on plan to monitor safety |
Plan for coping with dangerous or overwhelming thoughts or feelings |
Psychotherapy is scheduled to begin or continue |
Youth and family are able to articulate plans for emergencies |