Suicide Prevention and Suicide

Adolescents at Risk of Suicide Today, alarming numbers of young people are contemplating taking their own lives, and many follow through on their suicide ideations to actually kill themselves or to make an attempt. In sum, suicide represents the second-leading cause of death for people aged 15 to 34 years and is the third-leading cause of death among young people aged 10 to 14 years (Suicide facts at a glance, 2015).

To gain some additional insights into these issues, this case study provides a description of hypothetical 14-year-old runaway Caucasian adolescent, "Jane," who as referred from a homeless shelter with suicide ideations to determine what screening and testing should be performed, a discussion concerning current recommended treatment protocol, drugs and non-pharmacological interventions, and a description of expected treatment outcomes including a corresponding time frame and follow-up plan.

Finally, a summary of the research and important findings concerning adolescents such as Jane who are at risk of suicide are presented in the conclusion. Review and Discussion 1. Topic description & anticipated examination findings The subject in this case study is Jane, a representative teenager who ran away from home 2 months ago to get away from an abusive step-father and noncommittal biological mother.

Since that time, Jane reports having engaged in sexual acts in return for food and drugs as well as several instances of shoplifting for food but claims she has never been caught. The client appears malnourished, dehydrated, dirty and disheveled with torn clothes and matted hair. The client also admits to contemplating suicide before she ran away and notes that the frequency of these ideations has increased significantly in recent weeks.

When asked if she had made any firm plans for carrying out a suicide, Jane concedes that she does not have any concrete ideas but has alternatively considered jumping in front of a fast-moving car or taking an overdose of a drug that "could do the job." The client presents seeking help to "turn her life around" and to address her suicidal thinking patterns. Unfortunately, Jane's case is certainly not unique or even uncommon. For instance, in 2013 (the latest figures available from the U.S.

Centers for Disease Control), nearly one-quarter (22.4%) of female adolescents and just over one in ten (11.6%) male adolescents had seriously considered taking their own lives at some point during the previous year (Suicide facts at a glance, 2015). Moreover, nearly as many male adolescents (10.3%) and even more (16.9%) female adolescents had made plans concerning how they would commit suicide at some point during the previous year.

More troubling still, many adolescents act on these suicide ideations, with about twice as many female adolescents and 5.4% of male adolescents having made at least one suicide attempt during the previous year, and about the same ratio (3.6% of female adolescents and 1.8% of male adolescents) suffering an injury, overdose or poisoning episode as a result of a suicide attempt that required medical intervention and these rates are even higher for minorities in the U.S.

(Suicide facts at a glance, 2015), making the need for timely and accurate assessment essential as discussed below. 2. Patient assessments needed The assessment of adolescents such as Jane for suicide includes determining their individual needs in order to formulate an efficacious intervention (National Action Alliance for Suicide Prevention, 2013). In sum, patient assessment is needed to identify the reasons that adolescents are contemplating suicide, with a specific focus on the various social and clinical factors that must be taken into account in any type of intervention (National Action Alliance for Suicide Prevention, 2013).

There are several assessment tools available, some of which are in the public domain, that are specifically designed for use with adolescents including those set forth in Table 1 below. Table 1 Suicide risk assessment instruments Assessment Instrument Description/Applications Suicidal Ideation Questionnaire (SIQ) The SIQ was developed for use with high school-aged youth, and a slightly different version (the SIQ -- JR) is available for ages 12 -- 14 years. The questionnaires are presented as paper-and-pencil tasks or by computer-assisted administration.

There are 30 items (questions) in the SIQ and 15 in the SIQ-JR, all focusing on suicidal ideation. Youth are asked how often they experience the thoughts described in the question, selecting from six responses that range from "never" to "almost every day." Norms are available indicating the scores that should raise concern about suicide risk. The SIQ has been studied with a wide range of youth in varied clinical and non-clinical situations, as well as with different cultural backgrounds.

Substantial research on the SIQ has demonstrated its good psychometric properties, as well as its ability to identify youth who have histories of suicide attempts or who may make future suicide attempts. Suicidal Behaviors Questionnaire-Revised (SBQ-R) The 14-item SBQ-R and the 4-item SBQ-R were originally developed for use with adults, but subsequently have been studied and used with adolescents.

On the more-frequently used SBQ-R, youth check any of five responses to whether they have experienced thoughts about killing themselves, whether they have told anyone before about it, and how likely they believe it is that they will attempt suicide someday. The SBQ-R's brevity makes it the quickest screening method available for suicide risk assessment. Validation research has been favorable (identifying youth who were at risk according to other predictors), but use in juvenile justice settings -- and SBQ-R research in those settings -- has been limited.

The SBQ-R's greatest value lies in its validation with adolescents in general, its simplicity and ease of administration, and its absence of cost for materials because it is in the public domain. Global Appraisal of Individual Needs -- Short Screener (GAIN-SS) The GAIN-SS is a screening companion to a more comprehensive tool called the Global Appraisal of Individual Needs (GAIN). The GAIN is widely used as a structured way to identify the behavioral and mental health service needs of youth.

The GAIN requires up to two hours to administer and the GAIN-SS was designed to "screen out" individuals who might not need the more extensive GAIN evaluation. The GAIN-SS has four scales: Internalizing Disorder, Externalizing Disorder, Substance Use Disorder, and Crime/Violence. Each scale has five questions, which are posed to the youth in an interview (not paper-and-pencil). There is no suicide scale, but the Internalizing cluster inquires about depressed mood and includes one item on suicide ideation.

Thus, the Internalizing component of the GAIN-SS acts as a suicide risk screen within the context of the GAIN assessment system. The GAIN-SS is in the public domain, and therefore has no per-case cost Source: Adapted from National Action Alliance for Suicide Prevention, 2013, pp. 5-6 These assessment instruments typically evaluate various general risk factors such as having low self-esteem, being depressed, substance abuse or a history of childhood abuse as well as situation factors such as the loss of a loved one or a failed close relationship (King & Price, 2009).

Likewise, assessment should also take into account any verbal clues during the time of assessment such as, "Things would be better without me around" or "I want to die" (King & Price, 2009, p. 255).

While these types of verbal clues are clearly evidence concerning the thought patterns of young people who may be contemplating suicide, the diagnostic screening process involved can be far more complex and difficult to interpret accurately due to the tumultuous and unpredictable aspects of adolescent life that make distinguishing actual suicide ideations from normal reactions to the human condition incredibly problematic as discussed further below. 3.

Diagnostic screening/testing with potential results & interpretation One of the more challenging and confounding issues involved with diagnostic screening of adolescents concerns the turbulent period in their lives and their natural responses to these seemingly major problems. It is reasonable to posit that everyone remembers just how important and even earth-shattering rejection or ridicule can be during adolescence, and it is little wonder that when taken to their extreme, these forces combine to create a sense of helplessness and hopelessness among young people today.

Indeed, even the aforementioned screening instruments that have proven reliability and validity are unable to capture the entire range of psychological responses to the stressors that characterize adolescence, making the need for accurate diagnostic screening and testing all the more important (Horwitz & Wakefield, 2007). Notwithstanding this overarching consideration, many clinicians may easily misinterpret the findings from even the best assessment instruments without taking into account other potential disorders that may be causing adolescent suicide ideations.

In this regard, Horwitz and Wakefield (2007) emphasize that, "A second-stage diagnostic screening may eliminate many of these errors but also applies symptom-based DSM criteria to adolescents' labile emotions, possibly still yielding substantial false-positive identifications of depressive disorder and suicide risk" (p. Nor thus far is there scientific evidence that provides support for the effectiveness of teen screening (Horwitz & Wakefield, 2007)orHor. 4.

Current recommended treatment protocol, drugs, non-pharmacological plan At present, there are a few specialized evidence-based interventions that are available to help young people respond to the pressures in their lives that can cause suicidal ideations, including pharmacological and non-pharmacological treatments that are specifically targeted at minimizing suicide risk (Interventions for suicide risk, 2017). Some of the more commonly used nonpharmacological interventions for youths at risk for suicide at present include the following: 1. Non-demand "caring contacts"; 2. Structured, problem-solving therapies, and, 3.

Collaborative assessment and treatment planning but each intervention should be carefully tailored to the individualized needs of the patient (Interventions for suicide risk, 2017). 5. Expected treatment outcome(s) with time frame & follow-up Most young people who express some indication of a desire to commit suicide never follow through on the act itself, but this does not mean that adolescents who exhibit the warning signs of suicide should be ignored (National Action Alliance for Suicide Prevention, 2013).

Rather, an evidence-based, time-bound treatment regimen should be provided that requires active engagement on the part of the adolescent, including any family support system that may be available for this purpose (Horwitz & Wakefield, 2007)orHor. Left untreated, however, young people may not ever have the opportunity for follow-up treatments if the initial intervention is ineffective, making the need to identify factors that can adversely affect patient compliance essential as discussed below. 6.

Factors that may affect patient compliance One of the harsh realities in counseling young people is the fact that they may have already made their minds up concerning the intractability of their problems and the futility of trying to make things better. Besides this factor, other issues that may affect patient compliance with a suicide intervention include a wide array of social and psychological problems that have either been undetected or undertreated (Maris & Berman, 2000). Therefore, educating.