Recommendations for perioperative care of adolescents at risk for suicide

Abstract

Suicide is one of the leading causes of death for the adolescent population, and as such, should be considered when adolescents have any contact with the healthcare system, including perioperative appointments. Although some surgical facilities screen patients with a history of suicide attempt or severe mental health conditions, many adolescents who have died by suicide do not have official mental health diagnoses or history of previous suicide attempt. Because of the impact surgery can have on mental health, each adolescent should be screened for suicide risk during pre-surgical consult appointments to assess suicide risk and take proper precautions, as needed. Suicide screening should be implemented as part of the focused assessment prior to surgery to more comprehensively combat the rising suicide rates of adolescents. This paper provides recommendations to direct care of adolescent surgical patients at risk for suicide.

Clinical Issues — August 2024

“…According to the Centers for Disease Control and Prevention, suicide was the second leading cause of death in children aged 10 to 14 in the United States in 2021 1 . Suicide during adolescence is a prominent public health and patient safety issue; health care personnel “should be aware of suicide prevalence in this population, and incorporate strategies to identify patients at risk,” 2 (p69) including in the perioperative setting 2,3 . Surgery can have a negative effect on an adolescent patient's mental health because they may experience pain, impaired mobility, decreased independence, or receive opioids during their recovery 2 .…”

“…Suicide during adolescence is a prominent public health and patient safety issue; health care personnel “should be aware of suicide prevalence in this population, and incorporate strategies to identify patients at risk,” 2 (p69) including in the perioperative setting 2,3 . Surgery can have a negative effect on an adolescent patient's mental health because they may experience pain, impaired mobility, decreased independence, or receive opioids during their recovery 2 . Existing adolescent suicide risk factors can increase postoperatively 2 .…”

“…Surgery can have a negative effect on an adolescent patient's mental health because they may experience pain, impaired mobility, decreased independence, or receive opioids during their recovery 2 . Existing adolescent suicide risk factors can increase postoperatively 2 . Early detection of suicide risk through screening provides an open line of communication, the opportunity to destigmatize talking about suicide, and a chance to provide patients and families with education and resources for appropriate follow‐up 4 …”

“…The team should include perioperative RNs, perianesthesia RNs, RNs from receiving patient care units, education specialists, child life specialists, surgeons, anesthesia professionals, quality personnel, risk personnel, and behavioral health professionals. Suicide screening implementation considerations may include where the screening will take place (eg, preoperative unit, preadmission testing unit, clinic); 2 when the screening will take place (eg, day of surgery, within 30 days of surgery); 2 who will conduct the screening (eg, preoperative RN, clinic RN, anesthesia professional, surgeon, other licensed practitioner); 5 where the screening and results will be documented; 8 what educational material and follow‐up instructions will be provided for the patient or family; 7 how to include the screening risk results in perioperative communication (eg, the surgical safety checklist, hand‐off communication); 9 and what follow‐up actions should be taken based on screening results, including the time frame and person responsible for implementation (eg, behavioral health professional, hospital provider, or team responsible for behavioral health consultations to complete follow‐up suicide risk assessments and plan of care) 5 …”