Division of Child and Adolescent Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania 15213, USA
Address for correspondence: Dr. David Brent, Western Psychiatric Institute & Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213. Voice: 412-624-5172; fax: 412-624-7997.
brentda{at}msx.upmc.edu
In this review, a framework for the assessment of suicidal risk
in the adolescent is described, based on existing epidemiological
and clinical studies. The assessment of risk can then be used
to determine the immediate disposition, intensity of treatment,
and level of care. Furthermore, the assessment of psychiatric
and psychological characteristics of the individual and family,
as well as the motivation and precipitants for the suicidal
episode, can be used to target areas of vulnerability and thereby
help the patient reduce the risk of recurrent suicidal behavior.
The approach to treatment, guided by the assessment, uses a
model of suicidal behavior that is based on our clinical experience
and the few extant clinical trials of the treatment of suicidal
behavior. Recommended interventions involve treatment of psychopathology;
amelioration of cognitive distortion and difficulties with social
skills, problem-solving, and affect regulation; and family psychoeducation
and intervention. Given the chronic and recurrent nature of
the conditions associated with adolescent suicide attempts,
a long-term care plan involving both continuation and maintenance
treatment is advocated. Further research is necessary to identify
the most effective approaches to the treatment of adolescent
suicide attempters.
