Child Suicide Screening Methods: Are We Asking the Right Questions? A Review of the Literature and Recommendations for Practice

Suicidal ideation and executive functioning in pediatric cancer

OBJECTIVE

Neurocognitive impairments and psychological distress are among the most common difficulties experienced by children treated for cancer. Elevated rates of suicidal ideation (SI) are documented among cancer survivors, and a link between neurocognitive deficits and SI is evident, yet the relationship between SI and pediatric cancer-related neurocognitive effects has not yet been studied.

PARTICIPANTS AND METHODS

Participants were 166 pediatric cancer patients (57.8% Brain Tumor, 31.3% leukemia, 10.8% other cancers) aged 6-23 (M = 11.57, SD = 3.82; 45.8% female) referred for neuropsychological surveillance. SI prevalence was measured by parent, teacher, or patient endorsement of self-harm related items on informant-report measures (e.g., the Child Behavior Checklist). Executive functioning (Behavior Rating Inventory of Executive Function), ADHD symptoms (ADHD Rating Scale), and performance-based measures were compared between those with SI and those without.

RESULTS

17.5% of pediatric cancer patients experienced SI, of which 44.7% had self-endorsement only, 58.5% parent-endorsement only, 20.6% teacher-endorsement only, and 24.1% had two endorsements. Those with SI had significantly greater impairments in global executive composite scores by both parent- and teacher-report (ps < 0.05). Parents of children with SI endorsed significantly more inattention symptoms (M = 6.10, SD = 15.48) than those without SI (M = 50.56, SD = 8.70; p < 0.01), but hyperactivity symptoms did not differ. Intellectual and executive function performance did not differ between those with and without SI (ps > 0.1).

CONCLUSIONS

An elevated number of children treated for cancer experience SI and related neurocognitive problems. Screening for SI and further assessment of the connection between executive functioning and SI in pediatric cancer populations is needed.

Suicide in the pediatric population: screening, risk assessment and treatment

The number of children and adolescents dying by suicide is increasing over time. Patterns for who is at risk are also changing, leading to a need to review clinical suicide prevention progress and identify limitations with existing practices and research that can help us further address this growing problem. This paper aims to synthesise the literature on paediatric suicide screening, risk assessment and treatment to inform clinical practice and suicide prevention efforts. Our review shows that universal screening is strongly recommended, feasible and acceptable, and that there are screening tools that have been validated with youth. However, screening may not accurately identify those at risk of dying due to the relative rarity of suicide death and the associated research and clinical challenges in studying such a rare event and predicting future behaviour. Similarly, while risk assessments have been developed and tested in some populations, there is limited research on their validity and challenges with their implementation. Several promising suicide-specific treatments have been developed for youth, but overall there is an insufficient number of randomised trials. Despite great need, the research evidence to support screening, risk assessment and treatment is still limited. As suicide rates increase for children and adolescents, continued research in all three domains is needed to reverse this trend.

Advanced practice registered nurses attitudes toward suicide in the 15- to 24-year-old population

PURPOSE

The purpose of this study is to assess advanced practice registered nurses (APRNs) attitudes toward suicide in the 15- to 24-year-old population.

DESIGN AND METHODS

A convenience sample of national psychiatric and pediatric APRNs was obtained from postings on professional websites and sending invitations to members utilizing anonymous Qualtrics^ⓒ survey that included demographic questions and the Suicide Opinion Questionnaire (SOQ).

FINDINGS

The pediatric APRNs demonstrated more positive attitudes toward suicide as measured by the SOQ when individual items were analyzed.

PRACTICE IMPLICATIONS

One of the outcomes of this study is to raise awareness and foster prevention related to suicide for advanced practice registered nurses and the 15- to 24-year-old population.