Characterizing suicidal intent among suicidal adolescents: a systematic review

Suicidal intent contributes both to the assessment of suicide risk and to long-term prognosis in adults. Although suicidal intent is a key component in suicide risk assessment, its specific features and clinical implications in adolescents after a suicide attempt remain underexplored in the literature. However, it could represent an improvement in the assessment and prognosis of adolescent suicidal crisis. The aim of this study is to describe how suicidal intent manifests in adolescents after a suicide attempt, and how it relates to associated clinical and contextual characteristics.

We conducted a systematic review assessing suicidal intent in adolescents after a suicide attempt adhering to PRISMA guidelines. Five databases were searched up to September 2023. Seventeen studies met the inclusion criteria. We excluded studies focusing solely on suicidal ideation or on non-suicidal self-injury. Data were extracted and synthesized narratively. Study quality was assessed using standard tools.

Several studies suggest that suicidal intent may be more frequently reported in older adolescents, with a significant difference before and after the age of 16. High suicidal intent seems to be more frequently linked to internalized disorders. While suicidal intent does not appear directly linked to the lethality of the attempt, the highest level of suicidal intent reported across previous attempts may represent a prognostic marker for later suicide mortality.

It seems essential to refine existing assessment tools or develop new ones specifically adapted to adolescents, in order to assess suicidal intent while taking into account the specificities of the adolescent population. This would help optimize interventions and support for both the patient and their family.