Pediatric management of suicidal behavior

Emergency evaluation of the adolescent suicide attempter presents the pediatrician with a complex challenge. The attempter is acutely ill, in a psychosocial crisis, and may have one or more major mental disorders and a highly disturbed family. The adolescent rarely has planned the attempt for more than a few minutes, and usually does not know the dangerousness of the chosen method. Suicide attempts are quite common among adolescents and suicide quite rare, yet the risk of later death among attempters is substantial. Suicide is associated with a variety of problems and diagnoses, and in most ways attempters do not differ from other emotionally troubled adolescents. Suicide attempters and their families are often quite resistant to treatment, and this resistance seems to increase with the number of problems identified. How should the clinician proceed? We have stressed the importance of rapid evaluation of parent and adolescent to identify individual and family risk factors (Table 1). As the number of risk factors increases, greater caution should be exercised. A short hospitalization can allow a more thorough evaluation of complicated cases. Brief, problem-oriented therapy (Table 2) is most likely to be accepted by the family and can result in rapid improvement. A smaller number of adolescents will require long term care.