Practitioner Review: Treatment for suicidal and self‐harming adolescents – advances in suicide prevention care

Abstract

Background Suicide is a leading cause of death globally in youths, and suicidal behavior and self‐harm are major clinical concerns. This article updates the previous practitioner review (2012) with the aims of integrating new research evidence, including that reported in this Special Issue. Methods The article reviews scientific evidence related to steps in the care pathway for identifying and treating youths with elevated suicide/self‐harm risk, specifically: (a) screening and risk assessment; (b) treatment; and (c) community‐level suicide prevention strategies. Results Review of current evidence indicates that major advances have been achieved in knowledge regarding clinical and preventive practices for reducing suicide and self‐harm risk in adolescents. The evidence supports the value of brief screeners for identifying youths with elevated suicide/self‐harm risk and the efficacy of some treatments for suicidal and self‐harm behavior. Dialectical behavior therapy currently meets Level 1 criteria (2 independent trials supporting efficacy) as the first well‐established treatment for self‐harm, and other approaches have shown efficacy in single randomized controlled trials. The effectiveness of some community‐based suicide prevention strategies for reducing suicide mortality and suicide attempt rates has been demonstrated. Conclusions Current evidence can guide practitioners in delivering effective care for youth suicide/self‐harm risk. Treatments and preventive interventions that address the psychosocial environment and enhance the ability of trusted adults to protect and support youths, while also addressing the psychological needs of youths appear to yield the greatest benefits. Although additional research is needed, our current challenge is to do our best to effectively utilize new knowledge to improve care and outcomes in our communities.

Sleep in youth with repeated self‐harm and high suicidality: Does sleep predict self‐harm risk?

“…Suicide is the second leading cause of death in adolescents ages 12‐17 in the United States (US), and rates of suicide, suicide attempts (SAs), and nonsuicidal self‐injurious behavior (NSSI) increase dramatically during adolescence (Asarnow & Mehlum, 2019; Glenn et al, 2017). Prior SAs and NSSI are among the most robust predictors of future SAs; and self‐harm, a broader variable defined to include SAs and NSSI, is an established predictor of suicide deaths (Hawton et al, 2012).…”

“…Prior SAs and NSSI are among the most robust predictors of future SAs; and self‐harm, a broader variable defined to include SAs and NSSI, is an established predictor of suicide deaths (Hawton et al, 2012). The value of differentiating between the two self‐harm sub‐types (SAs, NSSI) is somewhat controversial particularly outside of the United States due to frequent unclear intent (Asarnow & Mehlum, 2019) and common risk mechanisms may contribute to both SAs and NSSI. Moreover, accumulating data indicating that previous self‐harm predicts later deaths by suicide and other unnatural causes such as drug overdoses and accidents suggest the potential value of clarifying risk mechanisms across self‐harm sub‐types (Hawton et al, 2012).…”

Association between family history of suicide attempt and neurocognitive functioning in community youth

“…Another clinical avenue is incorporating family assessment and early supportive intervention when an individual makes a suicide attempt, as the other family members (e.g., child, sibling) may be experiencing their own psychiatric risk factors that are undetected. As family-based therapies have been shown to be efficacious for suicidal youth (Asarnow & Mehlum, 2019), a family-focused approach may be similarly beneficial for relatives of suicide attempters. As there are no clear intervention recommendations for youth with a FH, further research is needed to examine the effects of interventions focused on targeting neurocognitive functioning.…”

Inculcating Dispositional Optimism for Prevention of Mental and Substance Use Disorders Throughout and After the Coronavirus Disease-19 Pandemic

“…Suicide is one of the leading causes of death for adolescents, and young adults, with an alarming increase in its global incidence for the past 10 years. 1,2 At least one individual dies due to suicide every 40 seconds, and up to 8% of patients seeking emergency care have acknowledged being actively suicidal when questioned. 3 Half of all lifetime mental disorders generally start by the mid-teens, while about three-quarters of them start by the mid-20s.…”