Key clinical point: Suicide risk should be assessed in teens who present with mental health symptoms, not just those with clinically diagnosed mental disorders.
Major finding: About 20% of teens have thought about suicide, 10% of adolescents experienced serious suicidal ideation, and 7% attempted suicide by age 20 years.
Study details: An analysis of data from more than 1,600 participants in the Quebec Longitudinal Study of Child Development. Participants answered questions about suicidal ideation or suicide attempt in the past year at ages 13, 15, 17, or 20 years.
Disclosures: Six of the authors were supported by grants from a variety of Canadian and European agencies and the American Foundation for Suicide Prevention. All of the authors said they had no relevant financial disclosures.
Orri M et al. Pediatrics. 2020. doi: 10.1542/peds.2019-3823.
Interestingly, this study by Orri et al. found that there was not a peak in suicide attempts in mid-adolescence; instead, rates of attempts were stable throughout adolescence and serious suicidal ideation actually increased with age. This was an unexpected finding for me, and something I will be more mindful about in my clinical practice when seeing older teens and young adults. Additionally, all mental health problems – not just depression – evaluated in univariate analyses in the study were associated with suicidal thoughts and attempts. On multivariable analysis that accounted for the impact of the effect of comorbid mental health symptoms, depressive symptoms had the highest and most consistent correlation to suicidal thoughts, and conduct symptoms were associated with an increase in suicide attempts. The authors conclude that youth with mental health symptoms – not just those who meet diagnostic criteria – should be assessed for suicide risk.
I think this recommendation is important for pediatricians to include in care for teens. When we think about all of the topics we screen and counsel about – healthy diet and exercise, dental health, injury prevention, and screen time, to name just a few – it can seem overwhelming to “add one more thing” when many clinicians already feel stretched for time. Others may shy away because of their own discomfort or perceptions of patient or family distress around the topic or avoid screening because they feel they lack the skills or resources to help patients with suicidal thoughts. However, mental health problems – including suicide – are incredibly common and cause significant morbidity and mortality. Screening for suicide is important – remember, too, that you can save a life and decrease the second leading cause of death in teens!
In my subspecialty practice, we screen every new patient for suicide regardless of the reason for their visit and more often for those with mental health symptoms. I know this may seem onerous, but screening and counseling typically take under 5 minutes – and in many instances around 1-2 minutes. Having ready-to-go resources including mental health professionals to refer to, screening algorithms (such as protocols published in MedEdPORTAL or Family Practice Management), and suicide prevention resources for patients and family for those who screen positive can help expedite this process. I think these recommendations can be adapted with relative ease into any visit for a teen or young adult who is presenting with a mental health complaint.
Kelly A. Curran, MD, is an assistant professor of pediatrics at the University of Oklahoma in Oklahoma City. She is a member of the Pediatric News editorial advisory board. Dr. Curran said she had no relevant financial disclosures.