Assessment and treatment of the youthful suicidal patient.

Abstract

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.