The aftercare of adolescents with deliberate self-harm

Self-Injurious Thoughts and Behaviors Interview-Korean Version: Psychometric Properties

OBJECTIVE

There is currently no structured interview tool developed that comprehensively evaluates self-injurious thoughts and behaviors (SITB) in Korea. The Self-injurious Thoughts and Behaviors Interview (SITBI) collectively measures suicidal ideation, plans, gestures, attempts, and non-suicidal self-injuries (NSSI). The SITBI's reliability and validity have been established with it being widely used in English speaking countries. This study evaluated the psychometric validity of the Korean version of the SITBI (SITBI-K).

METHODS

The SITBI's validity as a diagnostic assessment tool for NSSI and suicidal behavior disorder (SBD), as defined by the Diagnostic and Statistical Manual of Mental Disorders-5th edition, was examined. Analyses were performed on 108 university students reporting experiences of suicidal thoughts and behaviors (female 84.26%, mean age=22.10, ±SD 3.33).

RESULTS

The SITBI-K displayed excellent interrater reliability, with a credible test-retest reliability at two months. Construct validity examined the correlation between the SITBI-K's modules and approved the self-report results. Appropriate convergent and discriminant validities were obtained for suicidal ideation, plans, gestures, attempts, and NSSI.

CONCLUSION

The SITBI-K showed excellent psychometric validity at a level comparable to the original. Its clinical utility for both NSSI and SBD diagnoses was confirmed.

Psychodynamics of self-directed destructive behaviour in adolescence

The Government white paper ‘Health of the Nation’ set a target for reduction of suicide rates by 15% by the year 2000. Although the document did not make specific reference to adolescence, it is no less important an issue in this age group than in adulthood since, along with accidental death and malignancy, suicide is one of the most common causes of death in late adolescence and early adulthood and there is an upward trend (Diekstra, 1993; McClure, 1994; Diekstra et al, 1995). How the reduction should be achieved is not clear, since suicide is a rare event which is the culmination of complex processes, and present knowledge does not give a firm foundation for evidence-based practice (Gunnell & Frankel, 1994).

Suicide in pediatrics: epidemiology, risk factors, warning signs and the role of the pediatrician in detecting them

Epidemiological data suggests suicide is uncommon in childhood but becomes an extremely serious issue among adolescents.

Several risk factors have been identified and include the presence of psychiatric illness, a previous suicide attempt, family factors, substance abuse, sexual and physical abuse, disorders in gender identity or bullying. Pediatricians have a primary role in searching for these risk factors, recognizing them and acting synergistically with other specialists to prevent and treat suicidal behavior.

Pediatricians should also be able to identify the “warning signs” for suicide since their presence implies a need for immediate action, as attempted suicide may occur in a few hours or days.

The use of antidepressant drugs and its association with suicidal risk in pediatric age is another topic of ongoing debate. Food and Drug Administration has recently introduced the so-called “black box” on antidepressants’ packages with the aim of gaining attention to the possible risk of suicide among adolescents who are treated with antidepressants, with a warning that the risk of suicide is higher when starting a therapy or while adjusting its dosage.

Community-based strategy to prevent deliberate self-harm in adolescence: an inquiry to find risk factors at school

BACKGROUND

Self-harm behaviors consist of parasuicidal behaviors, which represent "a deliberate destruction of body tissue, with or without suicidal intent". A theoretical model is the Experiential Avoidance Model. The most frequent risk factors are school distress, poor social integration, poor social and family support, drugs use, sexual abuse, altered sense of life and death, bad relationship with the body and unsolved body mentalization process.

OBJECTIVES

The objective of the present study was to perform an analysis of risk factors for self-harm behaviors, to help plan preventive actions.

PATIENTS AND METHODS

One questionnaire with specific scales was employed for students, whereas three semi-structured interviews were employed for teachers, all on distress perception and self-harm in school.

RESULTS

Data analysis confirms an association between self- cutting and alcohol use, sexual harassments, school dropout, threatening people, incommunicability with family members and negative relationship with the body and suicide attempts, with a clear tendency for males. In the interviews, teachers highlight self-injury as a dysfunctional relationship with the body and observe several risk markers of psychological distress.

CONCLUSIONS

The results confirm the available literature data, while noting that self-harming is a preponderantly male behavior. The results also signal the need to create opportunities to instruct teachers to combat the resistances and stereotypes of psychological distress.

Therapeutic interventions for suicide attempts and self-harm in adolescents: systematic review and meta-analysis

OBJECTIVE

Suicidal behavior and self-harm are common in adolescents and are associated with elevated psychopathology, risk of suicide, and demand for clinical services. Despite recent advances in the understanding and treatment of self-harm and links between self-harm and suicide and risk of suicide attempt, progress in reducing suicide death rates has been elusive, with no substantive reduction in suicide death rates over the past 60 years. Extending prior reviews of the literature on treatments for suicidal behavior and repetitive self-harm in youth, this article provides a meta-analysis of randomized controlled trials (RCTs) reporting efficacy of specific pharmacological, social, or psychological therapeutic interventions (TIs) in reducing both suicidal and nonsuicidal self-harm in adolescents.

METHOD

Data sources were identified by searching the Cochrane, Medline, PsychINFO, EMBASE, and PubMed databases as of May 2014. RCTs comparing specific therapeutic interventions versus treatment as usual (TAU) or placebo in adolescents (through age 18 years) with self-harm were included.

RESULTS

Nineteen RCTs including 2,176 youth were analyzed. TIs included psychological and social interventions and no pharmacological interventions. The proportion of the adolescents who self-harmed over the follow-up period was lower in the intervention groups (28%) than in controls (33%) (test for overall effect z = 2.31; p = .02). TIs with the largest effect sizes were dialectical behavior therapy (DBT), cognitive-behavioral therapy (CBT), and mentalization-based therapy (MBT). There were no independent replications of efficacy of any TI. The pooled risk difference between TIs and TAU for suicide attempts and nonsuicidal self-harm considered separately was not statistically significant.

CONCLUSION

TIs to prevent self-harm appear to be effective. Independent replication of the results achieved by DBT, MBT, and CBT is a research priority.

Increasing Understanding in Children of Depressed Parents: Predictors and Moderators of Intervention Response

We evaluated predictors and moderators of differential response to two family-based depression prevention programs for families with a depressed parent: a clinician-facilitated intervention and a lecture group intervention. Individual and family level variables were examined using regression analyses with generalized estimating equations. For the outcome of child understanding of depression, parental changes in child-related behaviors and attitudes predicted greater child understanding (p < 0.001). For the parent outcome of behavior and attitude change, across intervention conditions, younger parent age (p < 0.05), female parent gender (p < 0.01), more chronic and severe parental depression history (p < 0.05), lower SES (p < 0.05), and single-parent status (p < 0.05) were associated with better outcomes across conditions. Effect sizes were moderate, ranging from 0.4 to 0.7 SD. Family and marital functioning were not found to be predictors of any outcomes. When both parents were depressed at baseline, there was no difference in the clinician- versus lecture-based approach, and when only the father was depressed, families reported more changes with the clinician condition than with the lecture condition (p < 0.05). Findings from this study can help identify intervention strategies that are appropriate for different types of at-risk individuals and families.

Non-suicidal self-harm behavior within the previous year among 10th-grade adolescents in Istanbul and related variables

BACKGROUND

Non-suicidal self-harm behavior (SHB), which is a pervasive and dangerous problem, is frequent among adolescents and it is important to evaluate the associated psychological and social factors to better understand its nature and to plan treatment programs.

AIMS

Aim of the present study is to determine the prevalence of SHB and the associated variables such as substance use, psychological, behavioral and social factors among 10th-grade students in Istanbul/Turkey.

METHODS

Cross-sectional online self-report survey conducted in 45 schools from the 15 districts in Istanbul/Turkey. A representative sample of 4957 10th-grade students was studied between October 2012 and December 2012.

RESULTS

SHB within the previous year were reported by 14.4% of the students (n = 713). Lifetime suicidal thoughts or behavior, tobacco, alcohol and/or drug use, symptoms of depression, anxiety and impulsive, delinquent and aggressive behaviors were also associated with SHB in Turkish 10th-grade students.

CONCLUSIONS

The findings of the present study may be relevant in prevention and management of SHB as well as important problems among students, such as substance use, impulsive, delinquent, aggressive and suicidal behavior.

Practitioner review: Self-harm in adolescents

BACKGROUND

  Repeated self-harm in adolescents is common and associated with elevated psychopathology, risk of suicide, and demand for clinical services. Despite recent advances in the understanding and treatment of self-harm there have been few systematic reviews of the topic.

AIMS

  The main aim of this article is to review randomised controlled trials (RCTs) reporting efficacy of specific pharmacological, social or psychological therapeutic interventions (TIs) in reducing self-harm repetition in adolescents presenting with self-harm.

METHOD

  Data sources were identified by searching Medline, PsychINFO, EMBASE, and PubMed from the first available year to December 2010. RCTs comparing specific TIs versus treatment as usual or placebo in adolescents presenting with self-harm were included.

RESULTS

  Fourteen RCTs reported efficacy of psychological and social TIs in adolescents presenting with self-harm. No independently replicated RCTs have been identified reporting efficacy of TIs in self-harm reduction. Developmental Group Psychotherapy versus treatment as usual was associated with a reduction in repeated self-harm, however, this was not replicated in subsequent studies. Multisystemic Therapy (MST) versus psychiatric hospitalisation was associated with a reduction of suicidal attempts in a sample of adolescents with a range of psychiatric emergencies. However, analyses focusing only on the smaller subgroup of adolescents presenting with deliberate self-harm at the initial psychiatric emergency, did not indicate significant benefits of MST versus hospitalisation.

CONCLUSIONS

  Further research is urgently needed to develop TIs for treating self-harm in adolescents. MST has shown promise but needs to be evaluated in a sample of adolescents with self-harm; dialectic behavioural therapy and cognitive behavioural therapy for self-harm require RCTs to evaluate efficacy and effectiveness.

Group therapy for repeated deliberate self-harm in adolescents: failure of replication of a randomized trial

OBJECTIVE

To replicate a study, which found group therapy superior to routine care in preventing the recurrence of self-harming behavior in adolescents who had deliberately harmed themselves on at least two occasions.

METHOD

Single blind study with parallel randomized groups undertaken in three sites in Australia. The primary outcome measure was repetition of self-harm, assessed on average after 6 and 12 months. Secondary outcome measures included suicidal ideation, psychiatric disorder, and service use.

RESULTS

Seventy-two adolescents aged 12 to 16 years (91% female subjects) were randomized to group therapy or routine care. Primary outcome data were available for 68 of the 72 randomized participants. More adolescents randomized to group therapy than those randomized to routine care had self-harmed by 6 months (30/34 versus 23/34, chi = 4.19, p =.04), and there was a statistically nonsignificant trend for this pattern to be repeated in the interval of 6 to 12 months (30/34 versus 24/34, chi = 3.24, p =.07). There were few differences between the treatment groups on secondary outcome measures, other than a trend for greater improvement over time on global symptom ratings among the experimental group compared with the control group.

CONCLUSIONS

Our findings contradict those of the original study. Some differences in participant characteristics between the studies, along with less experience at the Australian sites in delivering the intervention, may have accounted for the different outcome. The benefit of group therapy for deliberate self-harm is unproven outside the environment in which it was originally developed.

Prevalence, course, incidence, and 1-year prediction of deliberate self-harm and suicide attempts in early Norwegian school adolescents

In this survey of early Norwegian school adolescents, the prevalence, course, and incidence of self-harm behavior with or without suicide intent were examined, in addition to predictors of self-harm for a 1-year follow-up period. Lifetime prevalence rates of self-harm without suicide intent and suicide attempts were 2.9% and 3.0%, respectively, while 1-year incidence rates were 3.6% and 1.7%, respectively. In multivariate analysis, five predictors significantly differentiated self-harmers from non-self-harming adolescents. Early school adolescents having frequent or intense suicidal ideation over an extended time period and attempting self-harm repeatedly with or without suicide intent should be identified and offered treatment.

Psychometric properties of the Beck Depression Inventory-II in nonclinical adolescent samples

This study examined the factor structure and psychometric properties of the Beck Depression Inventory-II (BDI-II; A. T. Beck, Steer, & Brown, 1996) in samples of high-school adolescents (N=414; 210 boys and 204 girls, ages 14-18 years). Confirmatory factor analyses provided satisfactory fit estimates for the two- and three-factor oblique solutions reported frequently in the extant literature. The solution to a general factor with domain-specific somatic and cognitive-affective factors was examined as an alternative model to previously established models for the current high-school sample data. Results provided stronger support for the general factor model. Estimates of internal consistency for scores on this instrument were high (coefficient alpha=.92, average interitem correlation=.35). The mean BDI-II total score for the nonclinical samples (M=12.50, SD=10.50) was compared with the mean scores reported for various adolescent normative samples in the extant literature. The BDI-II total score correlated moderately and significantly with scores on self-report measures of hopelessness (r=.63), anxiety (r=.53), and suicide-related behaviors (r=.57), providing support of adequate correlates for the BDI-II. Estimates of known-groups validity were evaluated using data from a small sample of 167 clinical adolescent inpatients. Specific study findings, limitations, and recommendations are discussed.

An audit of the NICE self-harm guidelines at a local Accident and Emergency department in North Wales

This paper reports the findings of a self-harm audit based on data collected at an A&E department in North Wales. The National Institute for Clinical Excellence (NICE) guidelines on the short term physical and psychological management of self-harm were published in 2004 and the audit was based on technical criteria recommended in the guideline booklet, including standards of psychosocial assessment, staff training and patient satisfaction information. The data in this study related to fifty consecutive self-harm attendances at the A&E department Ysbyty Glan Clwyd in the Spring of 2007. The hospital serves a mixed rural/urban population of approximately 250,000. Patient satisfaction questionnaires were made available to the group subsequently, whilst the staff training audit was distributed more widely to include emergency, medicine and mental health divisions of the Conwy & Denbighshire NHS Trust. The results demonstrated generally high standards of care on psychosocial assessment, though information relating to initial ambulance involvement in treatment was often unclear. The response to the staff-training questionnaire was an encouraging 44% and indicated wide variations between staff groups and areas of work. The patient satisfaction returns demonstrated favourable responses, with several comments added to expand on tick box replies. Service developments, as a result of the audit, include the proposal to provide mental health and self-harm training to all those staff likely to encounter the behaviour--not just to those who work in mental health. Patients, from the questionnaire, who express a willingness to become part of a mental health planning group are now provided details of the patient participation involvement (PPI) group, where their experiences can often inform service improvement. Meanwhile the case note audit has reinforced the need for a practical self-harm pathway which will ensure consistency.

No-suicide contracts and no-suicide agreements: a controversial life

OBJECTIVE

In this paper we describe the origins of suicide prevention contracting, identify the historical factors that led to the adoption of the intervention, and describe legal tensions that have emerged during its use.

CONCLUSIONS

It would appear that one of the most frequently used clinical interventions for responding to suicidality has established a place in clinical practice without evidence attesting to its efficacy. We develop some propositions about how and why this clinical technique has been able to consolidate its place in mental health practice and, in so doing, suggest that the original technique was able to secure a clinical place without much apparent resistance because of the confluence of a number of emerging theories and community trends.

Management of the depressed, suicidal child or adolescent

Two prominent risk factors for completed suicide and suicidal behavior in adolescents are previous suicide attempts and a diagnosis of a depressive episode. Adolescents with different degrees of suicidal risk and severity are referred or admitted to various clinical settings. Research has yet to identify clearly the treatment of choice for suicidal patients. Regardless, clinical interventions should be based on a thorough suicide risk assessment. Treatment strategies should be multidimensional, targeting suicidal behavior and the underlying psychiatric illness or other personality and environmental risk factors. Because adolescents are referred from one clinical setting to another, continuity of care must be one of mental health practitioners' major concerns. Lack of continuity of care places patients at an elevated risk for additional suicide attempts.

Adolescent suicide and suicidal behavior

This review examines the descriptive epidemiology, and risk and protective factors for youth suicide and suicidal behavior. A model of youth suicidal behavior is articulated, whereby suicidal behavior ensues as a result of an interaction of socio-cultural, developmental, psychiatric, psychological, and family-environmental factors. On the basis of this review, clinical and public health approaches to the reduction in youth suicide and recommendations for further research will be discussed.

Clinical management of deliberate self-harm in young people: the need for evidence-based approaches to reduce repetition

OBJECTIVE

To examine the evidence for the effectiveness of clinical interventions designed to reduce the repetition of deliberate self-harm (DSH) in adolescents and young adults.

METHODS

Electronic databases were searched for papers describing randomised and clinical control trials (RCTs) and quasi-experimental studies of interventions targeting adolescents and young adults presenting to clinical services following DSH or suicidal ideation.

RESULTS

Three RCTs, four clinical control trials and three quasi-experimental studies were identified. Group therapy, trialled in a RCT, was the only specific programme which led to a significant reduction in rates of repetition of self-harm. Attendance at follow-up did not improve significantly regardless of the intervention, while one clinically controlled trial of intensive intervention resulted in poorer attendance at follow-up. One quasi-experimental study of family therapy resulted in a significant reduction in suicidal ideation.

CONCLUSIONS

The evidence base for treatments designed to reduce the repetition of self-harm in adolescents and young adults is very limited. Expensive interventions such as intensive aftercare offer no clear benefit over routine aftercare. Given that deliberate self-harm among young people is a common clinical problem further good quality treatment studies are warranted. Careful consideration should be given to process evaluation to determine which individual components of any given intervention are effective.

Multisystemic therapy effects on attempted suicide by youths presenting psychiatric emergencies

OBJECTIVE

To evaluate the efficacy of multisystemic therapy (MST) in reducing attempted suicide among predominantly African American youths referred for emergency psychiatric hospitalization.

METHOD

Youths presenting psychiatric emergencies were randomly assigned to MST or hospitalization. Indices of attempted suicide, suicidal ideation, depressive affect, and parental control were assessed before treatment, at 4 months after recruitment, and at the 1-year posttreatment follow-up.

RESULTS

Based on youth report, MST was significantly more effective than emergency hospitalization at decreasing rates of attempted suicide at 1-year follow-up; also, the rate of symptom reduction over time was greater for youths receiving MST. Also, treatment differences in patterns of change in attempted suicide (caregiver report) varied as a function of ethnicity, gender, and age. Moreover, treatment effects were found for caregiver-rated parental control but not for youth depressive affect, hopelessness, or suicidal ideation.

CONCLUSIONS

Results generally support MST's effectiveness at reducing attempted suicide in psychiatrically disturbed youngsters, whereas the effects of hospitalization varied based on informant and youth demographic characteristics.

The suicidal child: assessment and management of adolescents after a suicide attempt

It has been estimated that for each completed suicide, there are 15 to 20 nonfatal suicide attempts. A prior suicide attempt can create a major elevation in the risk of subsequent attempt. A prior suicide attempt also is a strong predictor for eventual completed suicide. Consequently, management of an adolescent who attempts suicide is important. In this article, the authors examine various issues related to suicide risk in adolescents. The article focuses on key issues that should be included in a thorough assessment of adolescents who are referred for an evaluation during a suicidal crisis. The empirical literature is used as a guide for identifying risk factors that should be monitored and managed as part of a comprehensive treatment plan.

Staff knowledge and attitudes towards deliberate self-harm in adolescents

This study investigates knowledge, attitudes and training needs concerning deliberate self-harm (DSH) in adolescents, amongst a variety of professionals involved in the assessment and management of adolescence who self-harm. A questionnaire survey was completed by 126 health professionals working with adolescents who harm themselves. The main outcome measures were a knowledge measure and three attitude measures (generated using factor analysis). The mean percentage of correctly answered knowledge questions, across all professional groups, was 60%. With regard to knowledge, over three-quarters of participants were unaware that homosexual young men and those who had been sexually abused are at greater risk of DSH, whilst one third of staff were unaware that adolescents who self-harm are at increased risk of suicide. Staff who felt more effective felt less negative towards this group of patients (B=-0.21, p=0.03). Forty-two per cent of the participants wanted further training in DSH amongst adolescents.

Youth suicide risk and preventive interventions: a review of the past 10 years

OBJECTIVE

To review critically the past 10 years of research on youth suicide.

METHOD

Research literature on youth suicide was reviewed following a systematic search of PsycINFO and Medline. The search for school-based suicide prevention programs was expanded using two education databases: ERIC and Education Full Text. Finally, manual reviews of articles' reference lists identified additional studies. The review focuses on epidemiology, risk factors, prevention strategies, and treatment protocols.

RESULTS

There has been a dramatic decrease in the youth suicide rate during the past decade. Although a number of factors have been posited for the decline, one of the more plausible ones appears to be the increase in antidepressants being prescribed for adolescents during this period. Youth psychiatric disorder, a family history of suicide and psychopathology, stressful life events, and access to firearms are key risk factors for youth suicide. Exciting new findings have emerged on the biology of suicide in adults, but, while encouraging, these are yet to be replicated in youths. Promising prevention strategies, including school-based skills training for students, screening for at-risk youths, education of primary care physicians, media education, and lethal-means restriction, need continuing evaluation studies. Dialectical behavior therapy, cognitive-behavioral therapy, and treatment with antidepressants have been identified as promising treatments but have not yet been tested in a randomized clinical trial of youth suicide.

CONCLUSIONS

While tremendous strides have been made in our understanding of who is at risk for suicide, it is incumbent upon future research efforts to focus on the development and evaluation of empirically based suicide prevention and treatment protocols.

Psychosocial interventions for suicidal children and adolescents

This paper discusses the role of psychosocial intervention in the treatment of suicidal youth, summarizes the existing relevant literature, describes model programs for treating suicidal youth, and discusses efficacy-to-effectiveness issues in working with this population.

No-suicide contracts: an overview and recommendations

No-suicide contracts, in their various forms, can deepen commitment to a positive action, strengthen the therapeutic alliance, facilitate communication, lower anxiety, aid assessment, and document precautions. Conversely, they can anger or inhibit the client, introduce coercion into therapy, be used disingenuously, and induce false security in the clinician. Research on no-suicide contracts (frequency surveys, assessments of behavior after contracting, and opinions of users) has limitations common to naturalistic studies, and is now ready for more rigorous methods. Mental health professions should be trained to deal with suicidal individuals, including how to use no-suicide contracts. Good contracts are specific, individualized, collaborative, positive, context-sensitive, and copied. However, they are not a thorough assessment, a guarantee against legal liability, nor a substitute for a caring, sensitive therapeutic interaction. No-suicide contracts are no substitute for sound clinical judgment.

Practice parameter for the assessment and treatment of children and adolescents with suicidal behavior. American Academy of Child and Adolescent Psychiatry

These guidelines review what is known about the epidemiology, causes, management, and prevention of suicide and attempted suicide in young people. Detailed guidelines are provided concerning the assessment and emergency management of the children and adolescents who present with suicidal behavior. The guidelines also present suggestions on how the clinician may interface with the community. Crisis hotlines, method restriction, educational programs, and screening/ case-finding suicide prevention strategies are examined, and the clinician is advised on media counseling. Intervention in the community after a suicide, minimization of suicide contagion or imitation, and the training of primary care physicians and other gatekeepers to recognize and refer the potentially suicidal child and adolescent are discussed.

Assessment and treatment of the youthful suicidal patient

In this review, a framework for the assessment of suicidal risk in the adolescent is described, based on existing epidemiological and clinical studies. The assessment of risk can then be used to determine the immediate disposition, intensity of treatment, and level of care. Furthermore, the assessment of psychiatric and psychological characteristics of the individual and family, as well as the motivation and precipitants for the suicidal episode, can be used to target areas of vulnerability and thereby help the patient reduce the risk of recurrent suicidal behavior. The approach to treatment, guided by the assessment, uses a model of suicidal behavior that is based on our clinical experience and the few extant clinical trials of the treatment of suicidal behavior. Recommended interventions involve treatment of psychopathology; amelioration of cognitive distortion and difficulties with social skills, problem-solving, and affect regulation; and family psychoeducation and intervention. Given the chronic and recurrent nature of the conditions associated with adolescent suicide attempts, a long-term care plan involving both continuation and maintenance treatment is advocated. Further research is necessary to identify the most effective approaches to the treatment of adolescent suicide attempters.

Deliberate self-harm in children: the nurse's therapeutic style

This article examines child health nursing skills in the management of deliberate self-harm in children and young people. In order for education to be effective (i.e. so that it changes practice) it must address the belief systems of the practitioner. It is suggested that such belief systems are embedded in collectively held tribal stories. The more challenging the patient's behaviour, the more powerful the influence of the tribal narrative--possibly as a defensive strategy. The authors outline strategies aimed at increasing the range and depth of the therapeutic response to episodes of self-harm, and outline nursing interventions in the management of self-harming children.

Nurses' and doctors' attitudes towards suicidal behaviour in young people

This paper presents an exploratory study performed to identify the attitudes towards suicidal behaviour in young people, amongst nurses (and nursing lecturers), and doctors working in in-patient medical and mental health care settings. The Suicide Opinion Questionnaire (SOQ) was administered to 59 participants. Responses were scored using eight clinical scales, and tested by using a Kruskal-Wallis one way analysis of variance. An Independent Sample t-test was used to analyse gender differences. Qualitative interviews were conducted in a sample of respondents. SOQ findings revealed no overall significant differences in the relevant groups of nurses and doctors, with the exception of gender and the clinical scale relating to a 'Cry for Help'. The focused interviews generated five categories relating to suicidal behaviour and young people. Nurses and doctors working in these areas possess a range of influential perceptions of suicidal behaviour and need to be considered in the contexts of care and treatment of young people.