Exploring the Link Between Suicidal Concern and Pharmacotherapy in Adolescents: Evidence from a Clinical Cohort

Background/Objectives: Suicidal risk is a major public health concern among adolescents. Pharmacological treatment in this population remains complex and often targets underlying psychiatric disorders rather than suicidal risk itself. This study aimed to examine associations between suicidal concern (SC) and psychotropic prescriptions in hospitalized adolescents with psychiatric disorders. A secondary aim was to assess whether suicidal risk level predicted pharmacological treatment at discharge (T1). Methods: A cross-sectional study was conducted on 224 adolescents (men age = 15.4, SD = 1.55). SC was assessed using the Columbia Suicide Severity Rating Scale (C-SSRS). Participants were categorized into SC and without SC (No Suicidal Concern-NSC) groups and further stratified by low and high suicidal risk. Psychotropic prescriptions at admission (T0) and T1 were compared, adjusting for age, gender, and psychiatric diagnoses. Results: The SC group showed more severe clinical presentations, including higher symptom burden and functional impairment. At discharge, they were more frequently prescribed antipsychotics and supplements, and more often received multiple medications compared to the NSC group. Logistic regression confirmed SC as a significant predictor of antipsychotic and supplement prescriptions at T1, independent of age, gender, and diagnosis. In contrast, suicidal risk level did not significantly predict specific prescriptions or polypharmacy prescriptions. Conclusions: SC appears to influence pharmacological decisions beyond diagnostic classifications, with a tendency toward risk-containment strategies. These findings emphasize the need for individualized, developmentally appropriate, and evidence-based treatment planning. Importantly, SC should be considered not only as a symptom but as a potential independent treatment target in adolescent psychiatry.