Study: Teen Suicide Prevention Needs to Be More Specialized, Improved

Teen suicide is even more complicated than previously thought. According to a new study in JAMA Psychiatry, simply providing adolescents some mental health treatment is not an effective form of suicide prevention.

The study explored the prevalence of suicide, and the prevalence and treatment of suicidal behaviors including ideation, plans and attempts.

The study found that a majority of suicidal teens did receive at least some type of mental health treatment, and often the treatment started before suicidal behaviors began. However, despite early treatment, the suicidal behaviors still happened.

These results showed the need for major changes in treatments for suicidal teens and prevention efforts, since current treatments and prevention efforts are not always effective in helping suicidal teens.

Study conclusions suggested that instead of providing general mental health treatment for suicidal behaviors and general suicide prevention efforts, both aspects need to be more specialized.

Researchers behind the study proposed that suicidal behaviors are somewhat common for U.S teens, and many of these teens have preexisting mental disorders.

However, the type of mental disorder that suicidal teens have seems to be associated with the type of suicidal behavior they experience (ideation, plans or unplanned/planned attempts).

Because of the different mental disorders being paired up with different types of suicidal behaviors, more specified treatment and prevention efforts are needed.

Experts shared their opinions on what can be done to make teen suicide prevention efforts and treatment more effective.

Carl Grody, a licensed independent social worker, said in an email that although the study at first may appear to suggest that mental health treatments are ineffective for suicidal teens, there are a lot of complex factors to consider.

Regardless, he does agree improvements need to be made in treatment, prevention and generally in how suicidal teens are dealt with.

“We need to include families in the treatment,” Grody said.

“Too often, families drop teens in a clinician's office and say, ‘Fix them.’ More often than not, the family system plays a big role in the teen's thoughts and behaviors, and family therapy is necessary to help the entire family tackle those issues instead of just targeting the teen for treatment.”

Audrey Cleary, a licensed psychologist, said in an email that more consistent treatment is needed to actually help suicidal teens.

“When it comes to psychotherapy, the number and regularity of sessions is important in predicting whether treatment will be effective (8 or more weekly sessions is more meaningful than single sessions occurring sporadically),” Cleary said.

More structured therapy could also be beneficial to suicidal teens.

Dr. Mark Edelstein, a board-certified child and adolescent psychiatrist, said in an email that although teens do have access to mental health treatment, it’s not necessarily the most effective kind of treatment available, which needs to be changed.

“ In most cases, evidence-based treatments – that is, the types of therapy with the greatest scientific evidence – are not what most therapists in the community provide,” Edelstein said.

“As in the rest of health care, there is a serious lag between research [and] what is available to people seeking treatment the real world.”

He added that the study makes it pretty clear that “suicidality is complicated.”

“It can be the result of any of a number of things – any of a variety of mental health conditions, behavior difficulties, personality and coping style, alcohol and substance abuse, and situational stress,” Edelstein said.

“This is a reminder that assessment and treatment planning must consider multiple domains in a child’s life, including health, school, family and social life.”

Isaiah Pickens, a clinical psychologist, said in an email that treatments need to be tailored specifically toward adolescents in order to be effective, and certain treatments like cognitive behavioral therapy and dialectical behavior therapy tend to be more effective for suicidal teens.

Elizabeth Lombardo, a psychologist, physical therapist and author, said in an email that there are a lot of life skills teens can be helped with as part of an overall suicide prevention.

“Higher self-confidence, resilience, sense of purpose and happiness are all buffers to suicidal intentions,” Lombardo said.

“They are also all very teachable. If we taught our teens (and those even younger) how to deal with the stresses of life, how to have healthy self-confidence, how to have a sense of purpose that is independent of others, then suicidal ideations and attempts would plummet.”

 

Self-mutilation Definition & Overview

 Self-mutilation or self-injury is any form of self-harm inflicted on your body without the intent to commit suicide. Self-mutilation is a compulsive act that may be performed to release emotional pain, anger, or anxiety ; to rebel against authority; to flirt with risk-taking; or to feel in control. In some cases, the behavior is outside your emotional control and related to a neurological or metabolic disorder.

The behavior is not considered socially appropriate. It is also not part of a religious custom or a form of art.

Prevention

The best preventative measure is to get help as soon as possible for depression, trauma, emotional problems, or other disorders that may lead to self-mutilation.

Causes

Self-mutilation is a severe impulse control disorder that is often associated with other psychiatric disorders, such as:

■Borderline personality disorder (most common)

■Depression

■ Substance abuse ( alcoholism or drug abuse )

■ Eating disorders ( anorexia or bulimia )

■Psychosis

■Antisocial personality disorders

■Post-traumatic stress disorder

 four are in Britain, where three are receiving treatment and the latest one is described as well; and one was in Germany in a patient from Qatar who has since been discharged from medical care.

Self-mutilation Symptoms & Diagnosis

 The symptoms of self-mutilation vary. The most common symptoms include:

■Cutting of skin with a sharp object (most common)

■Skin carving or burning

■Self-punching or scratching

■Needle sticking

■Head banging

■Eye pressing

■Finger, lips, or arm biting

■Pulling out one's hair

■Picking at one's skin

 Rarely, in very severe cases, self-mutilation can include:

■Broken bones

■Amputation

■Castration

■Suicide

Diagnosis

 Self-mutilation can be difficult to diagnose. People who self-mutilate often feel guilty and ashamed about their behavior and may try to hide it. A doctor may first see the physical harm caused by self-mutilation. To be diagnosed, symptoms should meet the following criteria:

■Preoccupation with physically harming oneself

■Inability to resist self-injurious behavior resulting in tissue damage

■Increased tension before and a sense of relief after self-injury

■Having no suicidal intent in the self-mutilation

To make an accurate diagnosis, the psychologist or psychiatrist will assess other conditions, like personality or mood disorders, and whether there is suicidal intent.