APRIL2002

Are there risk factors for suicide which increase the vulnerability of children served in our grant communities?

Suicide-the deliberate act of killing oneself-and suicidal ideation have been described by former Surgeon General David Satcher as at crisis levels among adolescents. Youth who are at the highest risk of committing suicide are those who have multiple stressors and are involved in multiple systems, which is the description of many children involved in our grant communities. These youths include:

• minority children-especially Native Americans, Hispanics, and African Americans;

•  female (lesbian) and male (gay) homosexuals;

• those with co-occurring diagnoses, especially depression and a conduct disorder, ADHD, or substance abuse;

• children who are aggressive and/or violent and have histories of physical and/or sexual abuse;

• runaways.

Children who have a history of repeat hospitalizations, especially for suicide attempts, have the highest rate of suicide attempts or completions. Parent/caretaker mental illness and domestic violence or substance abuse are also factors which increase suicidal ideation and attempts.

Many of the risk factors listed describe the youth who are involved in the grant communities. Thus, it is critical that as part of the assessment process, we include questions and data, which focus on suicidal risk. We must also remember culture race/ethnicity can influence how depression and aggression are expressed.

Indicators of developing depression in adolescents include:

• Unhappiness

• Gradual withdrawal into helplessness and apathy

• Isolated behavior

• Drop in school performance

• Loss of interest in activities that formerly were sources of enjoyment

• Feelings of worthlessness, hopelessness, helplessness

• Fatigue or lack of energy or motivation · Change in sleep habits

• Change in eating habits

• Self-neglect

• Preoccupation with sad thoughts or death

• Loss of concentration

• Increase in physical complaints

• Sudden outbursts of temper

• Reckless or dangerous behavior

• Increased drug or alcohol abuse

• Irritability; restlessness

More imminent danger signs include:

• Talking about death and wanting to die

• Suicidal thoughts, plans, or fantasies

• Previous suicide attempts

• Friends who have attempted suicide

• Giving away personal possessions

• Telling a friend about suicidal plans

• Writing a suicidal note

Treatment options:

• Cognitive behavioral therapies (self-control therapy or problem solving therapy, especially with family members) have shown "probable effectiveness" in reducing feelings of emotional distress, anger, sadness, anxiety, and depression in suicidal children.

• Interpersonal psychotherapy can be helpful with children experiencing loss, conflicts, and/or guilt.

• Medication management for suicidal patients has been focused on adults. However, selective serotonin reuptake inhibitors (SSRIs) have been successful in some trials for depression in youth and are the preferred treatment over tricyclic antidepressants.

References

U.S. Department of Health and Human Services. (1999). Mental Health: A Report of the Surgeon General. Rockville, MD, U.S. Department of Health and Human Services, Substance Abuse and Mental Health Administration, Center for Mental Health Services, National Institutes of Mental Health. Holden, W & Santiago, R. (Eds.). ( 2001). "System-of-Care Evaluation Brief " Vol 2, Issue 10. Center for Mental Health Services, Substance, July Ryan, C. P. & Fulterman, D. (1998). Lesbian and Gay Youth: Care and Counseling. New York: Columbia University Press. http://www.mental-health-matters.com/index.php