pediatrics
Suicidal Behavior in Children and Adolescents
Treatment
Crisis intervention, possibly including hospitalization Psychotherapy Possibly medications to treat underlying disorders, usually combined with psychotherapy Psychiatric referral Every suicide attempt is a serious matter that requires thoughtful and appropriate intervention. Once the immediate threat to life is removed, a decision regarding the need for hospitalization must be made. The decision involves balancing the degree of risk with the family’s capacity to provide support. Hospitalization (even in an open medical or pediatric ward with special-duty nursing) is the surest form of short-term protection and is usually indicated if depression, psychosis, or both are suspected. Lethality of suicidal intent can be assessed based on the following: Degree of forethought evidenced (eg, by writing a suicide note) Steps taken to prevent discovery Method used (eg, firearms are more lethal than pills) Degree of self-injury sustained Circumstances or immediate precipitating factors surrounding the attempt Mental state at the time of the episode (acute agitation is especially concerning) Recent discharge from inpatient care Recent discontinuation of psychoactive medications Medications may be indicated for any underlying disorder (eg, Depressive Disorders in Children and Adolescents , Psychiatric referral is usually needed to provide appropriate drug treatment and psychotherapy. Cognitive-behavioral therapy for suicide prevention and dialectical behavioral therapy may be preferred. Treatment is most successful if the primary care practitioner continues to be involved. Rebuilding morale and restoring emotional equilibrium within the family are essential. A negative or unsupportive parental response is a serious concern and may suggest a need for a more intensive intervention such as out-of-home placement. A positive outcome is most likely if the family shows love and concern. 1.Hesdorffer DC, Ishihara L, Webb DJ, et al: Occurrence and recurrence of attempted suicide among people with epilepsy.JAMA Psychiatry73(1):80-86. 2016. doi: 10.1001/jamapsychiatry.2015.2516 