Question

Please discuss the following:

How would you assess a youth’s risk for suicide? What tools would you use or factors would you consider? What ethical guidelines must you follow regarding suicidal clients? What strategies would you use to prevent suicide and/or what referrals would you make for additional services?

Identify the current needs for those dealing with loss of a family member from death or an impending death because of a terminal illness. Address services for families and for children individually. What is the grief process like and what factors might impact the process?

What are other mental health issues that frequently affect youth? What role does the advocate play in working with youth who have mental health issues? What legal/ethical considera

Answer 1

Question:

​How would you assess a youth’s risk for suicide? What tools would you use or factors would you consider? What ethical guidelines must you follow regarding suicidal clients? What strategies would you use to prevent suicide and/or what referrals would you make for additional services?

Answer:

• Suicide remains a leading cause of death among youth, and suicide ideation and behavior are relatively common in both normal and clinical populations. Clinicians working with young people are often required to assess for the presence of suicidal ideation, suicidal behavior, and other risk factors, and to determine the level of risk.
• Youth suicidal behavior and ideation (suicidality) remain a major public health concern because of their life-threatening nature and widespread prevalence. It is an issue that exists across psychiatric diagnoses and in varied socio-cultural populations. In fact, suicide is the third leading cause of death among youth (10-24 year olds), responsible for an estimated 4,600 deaths during 2004 in the US alone.
• The importance of the problem of suicidality is highlighted by its prevalence in the general population. A 2005 national survey by the US Centers for Disease Control and Prevention (CDC) found that approximately 17% of adolescents had seriously considered suicide in the past year, 13% had made a suicide plan, and 8% had attempted suicide at least once. Predictably, rates are even higher in depressed youth with approximately 60% reporting having thoughts of suicide and 30% actually attempting.

Assessment of Youth Suicidality

• Accurate assessment of suicidal ideation and behavior is a critical and necessary component of a comprehensive clinical evaluation of children and adolescents. Knowledge of the risk factors for suicide is a key prerequisite for assessment of risk. Risk factors have been identified by studies of clinical and normal populations as well as case control and psychological autopsy studies, and have been shown to vary with gender and age.

Risk Factors for Youth Suicidality

Psychiatric Diagnosis

• Up to 90% of young people who complete suicide have at least one psychiatric diagnosis as determined by psychological autopsy, and up to 70% experience two or more diagnoses.
• Depression is the most common diagnosis in adolescents who complete suicide4 and is highly prevalent in those with suicidal ideation and attempts.6Other major suicide risk factors that should be assessed and potentially targeted for treatment include anxiety disorders, substance abuse, and conduct and antisocial disorders, the latter two diagnoses being significantly more prevalent in male suicide completers.
• Brent and colleagues5 found that the suicide rate was greater in older adolescents (16 years and older) as they experienced higher rates of psychopathology, in particular substance abuse and greater motivation for suicide. While research evidence on the association between psychosis and suicidality is limited, risk of suicide for individuals with schizophrenia has been shown to be high during the first episode, 8 which often occurs in late adolescence, and during the five years following initial diagnosis.9

Past Suicidal Behavior

• Any suicide attempt, above and beyond being depressed, is a major risk factor for completed suicide and a further attempt.
• Past suicidal ideation has also been found to increase risk of future suicidal ideation, suicide attempt, and depression. Adolescents who are both depressed and have attempted suicide are at extremely high risk for both recurrent suicidal behavior and for completed suicide.

Family Factors

• Adolescents who complete suicide are more likely to come from a family with a history of suicide.They are also more likely to live in non-intact families and home environments characterized by high levels of conflict, poor attachment, and problematic communication. Assessment of parental depression and substance abuse is also indicated, as they are associated with adolescent suicide.
• Familial transmission of suicide almost invariably occurs with familial transmission of mood disorder, suggesting that clinicians also be aware of family history of mental illness, mood disorder in particular.

Additional Risk Factors

• Life stressors have been found to be significant risk factors for completed and attempted suicide in adolescents, particularly problems with authorities, academic difficulties, and relationship troubles (e.g. breaking up with a girlfriend or boyfriend).
• Other risk factors for suicidal behavior to keep in mind include sexual abuse, particularly with comorbid psychopathology, physical abuse, low socio-economic status, impulsivity, hopelessness, aggression, and poor social problem-solving skills.
• Gay, lesbian, and bisexual youth have been demonstrated to be at greater risk of suicidal ideation, and suicide attempt compared with heterosexual youth. Risk appears to be stronger in males than females