Pediatric Suicide
General considerations about suicide
- Contagious effect
Myths about suicide
- People who talk of suicide don’t commit suicide
- Suicide happens w/o warning
- Suicidal persons are fully intent on dying
- Once a person is suicidal, s/he is suicidal forever
- Improvement following suicide crisis means risk of suicide is over
- Suicide is inherited
- Asking someone about suicide, suggests it
Statistics
- Suicide account for 12% mortality in adolescent & young adult group
- As many as 4% of high school students have made attempt within previous 12 mo
- 8% of high school students have made attempt sometime in their lifetime
- As few as 1:8 of attempts by adolescents ever come to medical attention
Epidemiology
- Background
o Rate of adolescent suicide has tripled in past 3 decades
o Relationship to EtOH abuse & depression
o availability of firearms
o Family instability
o Prevalence of suicidal behavior – no central registry
- Age – completed suicide not a common in pre-pubertal kids
- Sex
o Female to male attempts 3-9:1
o Completed suicide 3:1
- Race of socioeconomic studies – whites at higher risk
- Method of suicide
o Firearms most common methods – use by women
o Hanging, jumping, CO intoxication & self-poisoning
o Suicide attempts
§ ODs
§ Wrist-cutting
- Circumstances of suicide
o Long-standing hx of problems (child & family)
o Progressive failure of coping techniques
o Failure of relatedness
- Precipitants
o Affective & antisocial symptomatology
o Substance abuse hx
o Previous threat or attempts
o Hx of other difficulties – impulsivity, poor interpersonal, problem-solving & social skills
- Family hx of psychiatric d/os
o Unipolar or bipolar affective d/os
o Antisocial d/o
o Attempted suicide & completed suicide in parent
o EtOH & substance abuse
- Family environment
o Marital breakdown – family discord & disruption
o One-parent household
o Frequent move
o Parental absence & abuse – loss of parent (particularly before age 12)
- Exposure to suicide
o Family & peers
o Media
- Medical illness
o Epilepsy
o HIV infx?
Tx
- Assess suicidality
o Psychiatric risk factors
o Poor social adjustment
o Family/environment
- After identification of suicidality (evaluation)
o Non-judgmental interview
o Psychiatric consultation
- Management of suicide attempters
o Assess suicidality/lethality
o Psychiatric hospitalization
- General psychiatric tx strategies
o No-suicide contracts
o Availability of 24-hr clinical back-up
o Removal of firearms
Prevention of suicide
- By non-psychiatric physicians – ask the question
- In schools – 1o prevention
- After suicide has occurred
- Hotlines & peer counseling
Conclusions
- Serious public health problem
o Contagious effect
o in general occurrence
Tags: antisocial symptomatology, peer counseling, prevention of suicide, Psychiatric hospitalization, suicide hotlines
