TABLE 2.
The suicidal/self-harming adolescent
| 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 |