Leo Sher, M.D.

My paper, “Teaching medical professionals and trainees about adolescent suicide prevention: five key problems” was published 10 years ago in the April-June 2012 issue of the International Journal of Adolescent Medicine and Health (1). In this article, I suggest that many health care professionals who have frequent contact with adolescents are not sufficiently trained in suicide evaluation techniques and approaches to adolescents with suicidal behavior.

I further suggest that suicide prevention efforts among adolescents are restricted by the fact that there are five key problems related to the evaluation and management of suicidality in adolescents:

1. Many clinicians underestimate the importance of the problem of adolescent suicidal behavior and underestimate its prevalence. Suicide is the third leading cause of death for Americans aged 15–24 years, after unintentional injuries/accidents and homicide, and accounts for more deaths among this age group than all natural causes combined. Mortality from suicide increases steadily throughout the teenage years.
2. There is a misconception that direct questioning of adolescents about suicidality is sufficient to evaluate suicide risk. However, physicians cannot rely on self-reporting by individuals at risk for suicidal behavior. Their information often proves misleading when suicidal patients wish to hide their intentions.
3. Another misconception is that adolescents with non-psychiatric illnesses do not need to be evaluated for suicidality. Distressed adolescents often present with medical problems, not psychological symptoms. Their feelings often manifest in unclear somatic symptoms.
4. Many clinicians do not know about or underestimate the role of contagion in adolescent suicidal behavior. Contagion is a process by which exposure to suicide or suicidal behavior of one or more individuals influences others to attempt or commit suicide. A person who was acquainted with the person who died by suicide is at an increased risk of suicide.
5. There is a mistaken belief that adolescent males are at lower suicide risk than adolescent females. In the U.S., adolescent females contemplate and attempt suicide more often than males, but males are four times more likely to die by suicide than are females. One of the reasons why adolescent males die from suicide much more often than adolescent females may be that they resort to violent methods of committing suicide, such as hanging, firearms and explosives, more frequently than females.

Educating medical professionals and trainees about the warning signs and symptoms of adolescent suicide and providing them with tools to recognize, evaluate, and manage suicidal patients represent a promising approach to adolescent suicide prevention.

Reference

1. Sher L. Teaching medical professionals and trainees about adolescent suicide prevention: five key problems. Int J Adolesc Med Health. 2012;24(2):121-3. doi: 10.1515/ijamh.2012.018.