Suicide in Children and Adolescents

New Interventions and Risk Factors

Michelle A. Patriquin, Katrina A. Rufino, Michelle A. Patriquin, Katrina A. Rufino

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781000460810
• Edition: 1
• Topic: Psicología
• Subtopic: Psicología anormal

This book highlights the current epidemiology of suicide among children and adolescents, as well as identifying important risk factors and evidence-based treatment options. To accomplish this, this book is organized into two major sections: (1) contributing factors to the emergence of child and adolescent suicide, and (2) evidence-based treatment of child and adolescent suicide.

Across studies, researchers discuss risk factors of anxiety, sleep problems, child sexual abuse, and violence perpetration, and conclude with treatment considerations including the Collaborative Assessment and Management of Suicidality (CAMS) and safety planning. From this body of work, it is clear that there is an urgent need to better understand and effectively treat child and adolescent suicide. The book will be a great resource for academics, researchers, and advanced students of Psychology, Psychiatry, Medicine, Sociology, Social Work and Youth Studies.

The chapters in this book were originally published as a special issue of Children's Health Care.

Child and adolescent suicide: contributing risk factors and new evidence-based interventions

Katrina A. Rufino and Michelle A. Patriquin

ABSTRACT

Our goal of this special issue is to detail and describe the current epidemiology of suicide among children and adolescents, as well as highlight important risk factors and evidence-based treatment options. To accomplish this, our issue is organized in two major sections: (1) contributing factors to the emergence of child and adolescent suicide, and (2) evidence-based treatment of child and adolescent suicide. Within the issue, authors discuss risk factors of anxiety, sleep problems, child sexual abuse, and violence perpetration, and conclude with treatment considerations including the Collaborative Assessment and Management of Suicidality (CAMS) and safety planning. Across studies, it is clear that there is an urgent need to better understand and effectively treat child and adolescent suicide.

Introduction

Current Centers for Disease Control and Prevention (CDC) data indicate that suicide is the second leading cause of death for both children and adolescents ages 10 to 17, second to only unintentional injury (CDC, 2017). This statistic is evidence of rising rates of suicide among children and adolescents, as ten years prior, suicide was the fourth leading cause of death among children ages 10 to 17 (CDC, 2017). Furthermore, suicide is now the 9th leading cause of death among children ages 5 to 11 (CDC, 2017). Unfortunately, these death statistics comport with recent literature which found a 92% increase in annual emergency department (ED) visits for suicide ideation and attempts from 2007 to 2015 for children under the age of 18, despite no statistically significant increase in the overall number of ED visits (Burstein, Agostino, & Greenfield, 2019). Those admitted to the ED for a suicide attempt increased by 79% from 2007 to 2015, and almost half (43.1%) of all ED visits for suicide ideation or a suicide attempt were for children between the ages of 5 and 10 (Burstein et al., 2019).

The rising rates of suicide attempts and death, particularly in younger children, indicate the urgent need to develop a better understanding of contributing risk factors to increased suicide risk and to design new evidence-based interventions for suicide in children and adolescents. As such, our special issue is organized in two sections: (1) papers that highlight contributing risk factors of increased suicide risk and (2) papers describing new treatments for suicide in children and adolescents.

Contributing risk factors to child & adolescent suicide

In order to effectively prevent and intervene, it is critical to build an empirically-based conceptualization of the contributing factors that increase child and adolescent suicide. In this section on contributing risk factors, the authors review unique factors that increase suicide risk including anxiety, sleep problems, child sexual abuse, and violent victimization. Notably, there are other factors that are not included in the present issue that also contribute to increased risk (e.g., seasonal trends with higher rates of suicide attempts in the school year, self-harm; Carbone, Holzer, & Vaughn, 2019).

To begin the special issue and open the section on risk factors, Covert and Fraire (2019) provide a comprehensive review of the literature on how specific anxiety disorders may serve as risk factors for suicide-related behavior in youth. An important take away from their review, is the relative lack of research on the role of anxiety disorders and suicide in youth. They conclude that social anxiety disorder appears to have the most developed literature, with the presence of social anxiety disorder related to increased risk for suicide-related behavior in adolescents. Additionally, generalized anxiety disorder also serves as a risk factor for suicidal behavior in adolescents. Importantly, the Covert and Fraire (2019) article makes a relevant clinical suggestion: when determining a child or adolescent’s suicide risk, we should not only be examining this within the context of depression – which is most commonly done in clinical practice – but also anxiety disorders, particularly given their high comorbidity with depression.

Given the importance of understanding the role of anxiety in suicide, a natural extension of this work is to examine how sleep problems relate to anxiety and suicide. Sleep problems are one of the most powerful, but understudied, predictors of all suicide outcomes – ideation, attempt, and death (Glenn et al., 2018). Moreover, sleep problems are highly prevalent in youth with anxiety disorders (Alfano, Patriquin, & De Los Reyes, 2015; Cowie et al., 2014; Patriquin, Mellman, Glaze, & Alfano, 2014). In the second paper in this special issue, Meir and colleagues (2019) present empirical findings from a longitudinal study on sleep and anxiety that demonstrate that children with greater anxiety are at higher risk of future suicidal ideation when there are childhood sleep disturbances and high percentages of rapid eye movement (REM) sleep present in early childhood. Their study indicates that the assessment of anxiety is important in clinical practice for determining suicide risk, but so is the assessment of sleep problems.

Outside these emerging new risk factors for suicide in youth, trauma is a well-studied risk factor particularly physical, emotional, and sexual abuse, and physical neglect (Zatti et al., 2017). The third paper in this section by Wilson and colleagues (2019) provides new evidence that examines the interaction between the types of childhood abuse and social support in relation to adulthood suicide ideation in female survivors of childhood sexual abuse or physical abuse. Their findings suggest that family and friend support may be especially helpful in supporting women who have experienced childhood sexual abuse to in turn reduce their risk of developing suicidal ideation in adulthood.

The last paper in this section by Rooney and colleagues (2019) extends the examination of traumatic events and suicide, by assessing the association between violent victimization and perpetration and suicide attempts. Using a sample of youth who previously experienced suicidal ideation, they examined the role of acquired capability via violent victimization and perpetration (Van Orden et al., 2010). Rooney and colleagues (2019) discuss new developmental conceptualizations of suicide risk and interesting clinical implications for practitioners working with adolescents including the regular assessment of trauma history and both violent and nonviolent externalizing behaviors.

Evidence-based treatment of child & adolescent suicide

In light of the increased rates of suicide among children and adolescents, the importance of suicide treatment for youth is apparent now more than ever. Recent studies have determined the efficacy of treatments adapted for youth from the adult literature for reducing suicide risk: Dialectical Behavior Therapy (DBT; McCauley et al., 2018; Mehlum et al., 2016, 2014), Cognitive Behavioral Therapy for Suicide Prevention (CBT-SP; Alavi, Sharifi, Ghanizadeh, & Dehbozorgi, 2013), Mentalization Based Therapy for Adolescents (MBT-A; Roussouw & Fonagy, 2012), and combinations thereof, such as Safe Alternatives for Teens and Youths (SAFETY; Asarnow, Hughes, Babeva, & Sugar, 2017) which is informed by both CBT and DBT. DBT studies demonstrate that while initial gains are strong leading to significant differences between groups (McCauley et al., 2018; Mehlum et al., 2014), follow-up at one year shows that the initial advantage of DBT for youth diminishes (McCauley et al., 2018; Mehlum et al., 2016) showing the strength of DBT for youth in a suicidal crisis, but also a need for the continued reinforcement of DBT skills. While both CBT-SP (Alavi et al., 2013) and MBT-A (Roussouw & Fonagy, 2012) have demonstrated significant improvement in suicide risk over the course of treatment compared to treatment as usual, neither study included follow-up after the conclusion of treatment to determine if treatment gains were sustained. Our special issue adds to this literature by reviewing two new treatments for youth, CAMS and safety planning.

First, Jobes and colleagues (2019) provide an in depth look at existing evidence-based interventions for the treatment of suicidal children and adolescents. They provide a thorough review of the epidemiology of prevalence rates and possible risk factors including childhood trauma, bullying, academic pressure, psychopathology, and biological factors. Additionally, Jobes and colleagues (2019) discuss the adaptation of CAMS, an already established evidenced-based suicide intervention for adults (Andreasson et al., 2016; Comtois et al., 2011; Ellis, Rufino, Allen, Fowler, & Jobes, 2015; Huh et al., 2018), for children and teens, as well as current studies showing support for its use with these populations. Jobes and colleagues (2019) indicate the preliminary evidence for the psychometrics of the SSF with youth and discuss the ongoing effectiveness studies currently in place for a youth version of CAMS.

The last paper of this special issue by Drapeau (2019) discusses the use of safety planning with suicidal patients as well as the research support for the practice in both adults and youth. He then examines the need for further research specific to safety planning with children and adolescents, and the unique hurdles that may be presented with this population, specifically the parent-professional collaboration. Novel applications of safety planning with youth are discussed and the author concludes with suggestions for clinicians, like adaptation for cognitive ability or involving parents.

Conclusion

The rates of suicide deaths and attempts in children and adolescents continue to rise. In this special issue, the contributing papers find that the significant pain experienced by these children and adolescents is related to multiple risk factors including anxiety, sleep problems, and trauma. It is our hope that understanding new risk factors for suicide in youth will lead to the design of novel interventions and treatments, such as the youth version of CAMS and new safety planning methods. Through innovative evidenc...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Contents
• Citation Information
• Notes on Contributors
• 1 Child and adolescent suicide: contributing risk factors and new evidence-based interventions
• 2 The role of anxiety for youth experiencing suicide-related behaviors
• 3 Sleep patterns and anxiety in children interact to predict later suicidal ideation
• 4 An examination of the interactive effects of different types of childhood abuse and perceived social support on suicidal ideation
• 5 Violent victimization and perpetration as distinct risk factors for adolescent suicide attempts
• 6 Establishing a research agenda for child and adolescent safety planning
• 7 The potential use of CAMS for suicidal youth: building on epidemiology and clinical interventions
• Index