*Articles identified as CME may no longer be available for credit; please check expiration dates.
Suicidal thoughts and behaviors are underpinned by environmental risk factors that interact with psychological risk factors (eg, affective, cognitive, social processes) and biological features (eg, neurobiological, molecular, genetic factors). Notably, exposure to interpersonal violence (childhood maltreatment, bullying, and community violence) has been linked prospectively to suicide attempts and deaths. Experiencing early life adverse events may induce changes in gene expression through epigenetic mechanisms and may alter both brain structure and function, facilitating maladaptive behaviors. Deciphering this complexity may help to identify pharmacologic and environmental interventions to reverse these long-term consequences.
Mental and substance use disorders are strong contributors to all suicide, indicating the importance of their effective management as part of suicide prevention strategies. The use of antidepressant drugs in youth has been highly controversial in recent years, and the warnings have been accused of discouraging doctors from prescribing antidepressants when they were clinically indicated. Otherwise, promising news about psychosocial interventions for adolescent self-harm and the efficacy of school-based preventive interventions addressing suicidal behaviors underline the benefit of both indicated and universal suicide preventive intervention in young people. There is much work to be done to better understand suicidal thoughts and behaviors among youth and ultimately efficiently improve their prevention.
Noncompliance with the norm, at an age when construction of identity is in process and refers to others, may weaken the self-esteem and constitute an important suicidal actor in adolescents though. Bullying and discrimination (related to physical appearance, disability, or sexual orientation) that adolescents face may increase suicidal risk. The internet has become an important platform for information and communication about suicide among young people. While it may be harmful (cyberbullying, “Blue Whale Challenge”) in vulnerable youths, social media may also play a preventive role and help to identify young people at high risk for suicidal behavior. Individualized web-based tools, machine-learning algorithms, and mobile apps offer new avenues for suicide prevention, whereas methodologically robust research studies to evaluate their safety, efficacy, and effectiveness are promptly needed.
Collection Contents
Recognizing the Clinical Characteristics of Youths at Risk
1
Clinical Differences Between Suicidal and Nonsuicidal Depressed Children and Adolescents
Rémy P. Barbe, Douglas E. Williamson, Jeffrey A. Bridge, Boris Birmaher, Ronald E. Dahl, David A. Axelson, and Neal D. Ryan
J Clin Psychiatry 2005;66(4):492–498
2
Contributing Factors and Mental Health Outcomes of First Suicide Attempt During Childhood and Adolescence: Results From a Nationally Representative Study
Hugo Peyre, Nicolas Hoertel, Coline Stordeur, Gaële Lebeau, Carlos Blanco, Kibby McMahon, Romain Basmaci, Cédric Lemogne, Frédéric Limosin, and Richard Delorme
J Clin Psychiatry 2017;78(6):e622–e630
3
Clinical Features of Depressed Children and Adolescents With Various Forms of Suicidality
Xianchen Liu, Amy L. Gentzler, Ping Tepper, Enikö Kiss, Viola Osváth Kothencné, Zsuzsanna Tamás, Ágnes Vetró, and Maria Kovacs
J Clin Psychiatry 2006;67(9):1442–1450
Transition From Self-Harm to Suicide
4
A Longitudinal Study of Nonsuicidal Self-Injury in Offspring at High Risk for Mood Disorder
Lara J. Cox, Barbara H. Stanley, Nadine M. Melhem, Maria A. Oquendo, Boris Birmaher, Ainsley Burke, David J. Kolko, Jamie M. Zelazny, J. John Mann, Giovanna Porta, and David A. Brent
J Clin Psychiatry 2012;73(6):821–828
Inflammation and Suicidality
5
Inflammatory Markers and the Pathogenesis of Pediatric Depression and Suicide: A Systematic Review of the Literature
Jae-Won Kim, Eva M. Szigethy, Nadine M. Melhem, Ester M. Saghafi, and David A. Brent
J Clin Psychiatry 2014;75(11):1242–1253
Sleep Disturbance and Suicidality
6
Objectively Assessed Sleep Variability as an Acute Warning Sign of Suicidal Ideation in a Longitudinal Evaluation of Young Adults at High Suicide Risk
Rebecca A. Bernert, Melanie A. Hom, Naomi G. Iwata, and Thomas E. Joiner
J Clin Psychiatry 2017;78(6):e678–e687
Internet Addiction Among Adolescents Increases Suicidal Risk
7
Internet Addiction and Its Relationship With Suicidal Behaviors: A Meta-Analysis of Multinational Observational Studies
Yu-Shian Cheng, Ping-Tao Tseng, Pao-Yen Lin, Tien-Yu Chen, Brendon Stubbs, Andre F. Carvalho, Ching-Kuan Wu, Yen-Wen Chen, and Ming-Kung Wu
J Clin Psychiatry 2018;79(x):17r11761
Risk Factors During College
8
Characteristics and Risk Factors for Suicide and Deaths Among College Students: A 23-Year Serial Prevalence Study of Data From 8.2 Million Japanese College Students
Chiyoko Uchida and Mai Uchida
J Clin Psychiatry 2017;78(4):e404–e412
Thought Patterns May Determine Level of Urgency
9
Cognitive Control Deficits Differentiate Adolescent Suicide Ideators From Attempters
Jeremy G. Stewart, Catherine R. Glenn, Erika C. Esposito, Christine B. Cha, Matthew K. Nock, and Randy P. Auerbach
J Clin Psychiatry 2017;78(6):e614–e621
Coping Strategies Play a Role
10
Responses to Depressed Mood and Suicide Attempt in Young Adults With a History of Childhood-Onset Mood Disorder**
Xianchen Liu, Amy L. Gentzler, Charles J. George, and Maria Kovacs
J Clin Psychiatry 2009;70(5):644–652
Suicidality in First-Episode Psychoses
11
Predictors of Suicide Attempt in Early-Onset, First-Episode Psychoses: A Longitudinal 24-Month Follow-Up Study
Vanessa Sanchez-Gistau, Inmaculada Baeza, Celso Arango, Ana González-Pinto, Elena de la Serna, Mara Parellada, Motserrat Graell, Beatriz Paya, Cloe Llorente, and Josefina Castro-Fornieles
J Clin Psychiatry 2013;74(1):59–66
Suicidality During Treatment for Depression
12
Suicidal Events in the Treatment for Adolescents With Depression Study (TADS)
Benedetto Vitiello, Susan G. Silva, Paul Rohde, Christopher J. Kratochvil, Betsy D. Kennard, Mark A. Reinecke, Taryn L. Mayes, Kelly Posner, Diane E. May, and John S. March
J Clin Psychiatry 2009;70(5):741–747
Active Screening
13
Patient Health Questionnaire Depression Scale as a Suicide Screening Instrument in Depressed Primary Care Patients: A Cross-Sectional Study
Lisa A. Uebelacker, Nicole M. German, Brandon A. Gaudiano, and Ivan W. Miller
Prim Care Companion CNS Disord 2011;13(1):e1–e6
14
A Risk Algorithm for the Persistence of Suicidal Thoughts and Behaviors During College
Philippe Mortier, Glenn Kiekens, Randy P. Auerbach, Pim Cuijpers, Koen Demyttenaere, Jennifer G. Green, Ronald C. Kessler, Matthew K. Nock, Alan M. Zaslavsky, and Ronny Bruffaerts
J Clin Psychiatry 2017;78(7):e828–e836
Prevention Strategies
15
Student Evaluation of the Yellow Ribbon Suicide Prevention Program in Midwest Schools**
Alexandra Flynn, Rosalee Zackula, Nicole M. Klaus, Liz McGinness, Susan Carr, and Matthew Macaluso
Prim Care Companion CNS Disord 2016;18(3):doi:10.4088/PCC.15m01852
16
Guns and Suicide: Are They Related?
Simrat Kaur Sarai, Bilal Abaid, and Steven Lippmann
Prim Care Companion CNS Disord 2017;19(6):17br02116
**Although this CME activity is expired, the posttest and answers are provided for your benefit.
Further Reading
The following articles, even though outside the specific scope of this collection, provide further information about diagnosing and preventing suicide and offer guidance on treating those bereaved by the loss of a loved who may die by suicide.
Consensus Statement
Assessment of Suicidal Ideation and Behavior: Report of the International Society for CNS Clinical Trials and Methodology Consensus Meeting
Free Article
Phillip B. Chappell, Michelle Stewart, Larry Alphs, Franco DiCesare, Sarah DuBrava, Jill Harkavy-Friedman, Pilar Lim, Sian Ratcliffe, Morton M. Silverman, Steven D. Targum, and Stephen R. Marder
J Clin Psychiatry 2017;78(6):e638–e647
Screening Tool Within the Electronic Medical Record
Electronic Clinical Decision Support for Management of Depression in Primary Care: A Prospective Cohort Study
Free HTML with registration
James M. Gill, Ying Xia Chen, Angela Grimes, James J. Diamond, Michael I. Lieberman, and Michael S. Klinkman
Prim Care Companion CNS Disord 2012;14(1):doi:10.4088/PCC.11m01191
Helping Those Left Behind
Treatment of Complicated Grief in Survivors of Suicide Loss: A HEAL Report
Free with subscription
Sidney Zisook, M. Katherine Shear, Charles F. Reynolds III, Naomi M. Simon, Christine Mauro, Natalia A. Skritskaya, Barry Lebowitz, Yuanjia Wang, Ilanit Tal, Danielle Glorioso, Julie Loebach Wetherell, Alana Iglewicz, Donald Robinaugh, and Xin Qiu
J Clin Psychiatry 2018;79(2):17m11592
If you are considering suicide or you know someone who needs help,
contact National Suicide Prevention Lifeline (USA): 1-800-273-(TALK) 8255