Challenges of Suicide Prevention in Children: A Thematic Analysis of Clinician Insights

Suicidal ideation and behaviors in preteens have increased in recent years. This study sought to describe clinical issues related to suicide prevention in children younger than 10 years old by clinicians who serve children.

Data were collected as part of the evaluation of the Zero Suicide initiative in New York State outpatient mental health clinics. Participants (N = 177 mental health clinicians) responded to the question of how working with suicidal children under the age of 10 yrs. differed from working with suicidal adolescents or adults. Clinician's open ended text responses to this question underwent thematic analysis using an inductive approach.

The identified themes included: (1) child's characteristics, e.g., impulsivity, limited insight, limited verbal skills, immature understanding of the death and suicide concepts, and general developmental differences; and (2) environmental factors, e.g., perception of a child's suicidality by others and complicated environment; both in the context of their effect on assessment and prevention methods. Additionally, (3) suicide risk assessment-barriers, such as ambiguity in the child's suicidal statements, difficulty evaluating suicide risk level, and problems with current assessment instruments; and facilitators, including use of age-appropriate language or other communication modalities, and use of collateral sources of information; as well as (4) suicide prevention interventions-barriers, including limited coping skills and child and parent engagement in treatment; and facilitators, such as psychoeducation, parent involvement, and modifying existing interventions.

Clinician responses indicate the need for evidence-based practice guidelines tailored to this population's characteristics. Recommendations for clinicians are discussed.