With suicide rising to the second-leading cause of death among adolescents (15 to 19 years old), the American Academy of Pediatrics (AAP) has updated guidelines advising how to identify and manage adolescents at risk. The AAP released a clinical report that replaces previous recommendations made in 2007. The updated report encourages pediatricians to screen adolescents for significant suicide risk factors, such as a history of physical or sexual abuse, use of drugs and alcohol, previous suicide attempt, bullying, sexual orientation, and personal mental health problems that predispose to suicide.
| Recent data has also shown that adolescents who use the internet more than 5 hours each day are at a higher risk of suicidality. Knowledge of the risk factors, especially regarding mood disorders, may assist in the identification of adolescents who are at higher risk. It is important to know and use appropriate techniques for interviewing adolescents at risk. Questions should be asked to elicit known risk factors. Depression screening instruments shown to be valid in adolescents include the Patient Health Questionnaire (PHQ)-9 and PHQ-2.
Mood disorders predisposing adolescents to suicidality can present in a variety of ways. While some adolescents may present with symptoms similar to those of depressed adults (feeling sad or down, loss of interest or pleasure in activities, weight gain/loss, etc.), other adolescents may present with irritability, with somatic symptoms, or with behavioral problems. |
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Intervention for adolescents at risk for suicide should to tailored to the adolescent’s need and the degree of suicide risk. The report documents evidence to suggest antidepressants may increase risk of suicide in some adolescents. However, treatment with antidepressant medication is important for appropriate youth when indicated. Additionally, careful monitoring of adolescents’ mental health and behavioral status is critically important, particularly when initiating or changing treatment. A recent meta-analysis of antidepressants for major depressive disorder in children and adolescents provides additional information about the risks and benefits of antidepressants in the treatment of major depressive disorder (MDD) in children and adolescents. For adolescents at risk for suicide, the guidelines also advise parents to remove guns and ammunition from the house and secure supplies of prescription and over-the-counter medications. |
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Click here to read the full report from the American Academy of Pediatrics.