Suicidal ideation and behaviour

Question 1

What is the second-most common cause of death in Canadian adolescents?

Answer 1

Suicide

Question 2

What percentage of all deaths among 15-19yo Canadians in 2011 were due to suicide?

Answer 2

25%

Question 3

What are risk factors for suicide?

Answer 3

1. Mental illness
2. Prior deliberate self-harm or suicide attempt
3. Impulsivity
4. Precipitating factors
5. Family factors
6. Lack of connection to psychosocial support

Question 4

When are self-harm behaviors associated with suicidal intent?

Answer 4

Only if adolescents report they are. Sometimes they are intended to cope with emotional pain

Question 5

What are some precipitating factors?

Answer 5

Stressors leading to feelings of rejection, inadequacy, humiliation, shame, and loss

Question 6

What are some common precipitants of suicidal behaviors among teens?

Answer 6

1. Break-up of romantic relationship
2. Conflict with family or peer
3. Recent or impending academic disappointment
4. Bullying
5. Disclosure of homosexual orientation
6. Legal involvement or impending court proceedings
7. Triggers for sexual or physical abuse
8. Exposure to suicide via media or people known to adolescent

Question 7

How should a recent suicide attempt and current suicidality be assessed?

Answer 7

1. Ideation
   - frequency, intensity, and quality of SI, coping strategies, feelings of hope
2. Intent
3. Plan
   Presence and details of plan and access to means

Question 8

What should the clinician determine when taking a history about the suicide attempt?

Answer 8

1. The method of the attempt;
2. Whether it was impulsive or planned;
3. The lethality of the method used;
4. The anticipated outcome;
5. Steps taken to decrease the likelihood of being discovered (if any); and
6. In the case of poisoning or substance misuse, feelings of anxiety or regret that led the adolescent to seek help following the attempt. The circumstances that led to parental awareness of the attempt and medical attention should also be elicited.

Question 9

What recommendations should be given to adolescents appropriate for outpatient management of SI?

Answer 9

1. Clear instructions regarding the importance of communicating SI or behaviors to identified trusted adults
2. Need for mental health f/u care
3. Availability of local crisis services and telephone lines
4. Use the ED if necessary

Question 10

What is an example of a validated suicide scale?

Answer 10

Columbia Suicide Severity Rate Scale