Content and Process of Adolescent Suicide Ideation: Implications for Risk Assessment

Differences in Reporting Suicide Ideation and Attempt: Implications for Suicide Risk Screening in Pediatric Primary Care

OBJECTIVE

Pediatricians are uniquely positioned to identify suicide-related risk, yet clinical practices as to when, how, and who gets screened may vary due to differences in policy statements on youth suicide risk screening in primary care. To address these differences, we examined agreement between reports of past suicide ideation (SI) and suicide attempt (SA) across multiple assessment methods and over time. We further explored associations across sociodemographic factors and severity of mental health symptoms on reporting patterns on these methods for adolescents at elevated risk.

METHODS

Adolescents (N = 162) with SI and/or SA were recruited from multiple clinical sites in and around New York City. Adolescents completed interviews and self-report measures validated to assess suicide-related risk, depressive symptoms, and anxiety symptoms.

RESULTS

Agreement between questions on verbal interviews over time was fair (κ = 0.38), with adolescents under-reporting lifetime SI as time from a crisis went by. Agreement between questions on self-report measures was moderate (κ = 0.51), with adolescents under-reporting past-month SI on a depression screen compared to a suicide-specific screen. Participants with less severe mental health-related symptoms were significantly less likely to report past-month SI consistently.

CONCLUSIONS

This study highlights important trends in suicide-related reporting patterns among adolescents at elevated risk for suicide and may have important implications for clinical practice guidelines. To capture more adolescents at risk for suicide, results not only support a universal screening approach using suicide-specific tools but may suggest the need to increase screening frequency in pediatric primary care.

How do adolescents consider life and death? A cognition-to-action framework for suicide prevention

Rising rates of suicide fatality, attempts, and ideations among adolescents aged 10-19 over the past two decades represent a national public health priority. Theories that seek to understand suicidal ideation overwhelmingly focus on the transition from ideation to attempt and on a sole cognition: active suicidal ideation - the serious consideration of killing one's self, with less attention to non-suicidal cognitions that emerge during adolescence that may have implications for suicidal behavior. A large body of research exists that characterizes adolescence not only as a period of heightened onset and prevalence of active suicidal ideation and the desire to no longer be alive (i.e., passive suicidal ideation), but also for non-suicidal cognitions about life and death. Our review synthesizes extant literature in the content, timing and mental imagery of thoughts adolescents have about their (1) life; and (2) mortality that may co-occur with active and passive suicidal ideation that have received limited attention in adolescent suicidology. Our "cognition-to-action framework for adolescent suicide prevention" builds on existing ideation-to-action theories to identify life and non-suicidal mortality cognitions during adolescence that represent potential leverage points for the prevention of attempted suicide and premature death during this period and across the life span.

Facets of Suicidal Ideation

According to SAMHSA (2023), approximately 16,600,000 American adults and teens reported having serious thoughts of suicide in 2022. While suicide prevention has primarily focused on suicide deaths and attempts, we contend that suicidal ideation (SI) deserves more in-depth investigation and should be an essential intervention target on its own. In support of this point, we provide three examples of ways to improve specificity in understanding of SI through the study of controllability of SI, the language used to assess SI, and measuring SI in real time. We also consider qualitative work on the content of SI, its treatment, and definitional considerations. We thus call for an increased general focus on SI within research, clinical care, and policy.

Pediatric suicide: Review of a preventable tragedy

Concepts of suicide are explored in this issue with a focus on suicide in children and adolescents. The epidemiology of pediatric suicide in the United States is reviewed; also, risk and protective factors, as well as prevention strategies, are discussed. Suicide in the pediatric athlete and the potential protective effect of exercise are examined. In addition, this analysis addresses the beneficial role of psychological management as well as current research on pharmacologic treatment and brain stimulation procedures as part of comprehensive pediatric suicide prevention. Though death by suicide in pediatric persons has been and remains a tragic phenomenon, there is much that clinicians, other healthcare professionals, and society itself can accomplish in the prevention of pediatric suicide as well as the management of suicidality in our children and adolescents.