Suicidal Ideation CLINICAL PEARLS: • Rates of completed suicide in the United States have consistently risen over the last two decades with significant increase in 44 states and it is the second leading cause in children and adolescents age 10 to 19 years. • Universal Screening is important given 17% of all high school students reported suicidal ideation in the last year, while 8% of American high school students report a suicide attempt. • When treating youth with depression and/or suicidal ideation; psychoeducation about removal of access to firearms, lethal weapons, medications and other potential self-harming items is important in prevention. • Almost half of suicide attempters have had a primary care physician visit within 30 days of attempt. • When treating psychiatric disorders, it is important to use evidence-based treatments. SSRIs are first-line treatments for depressive disorders. Psychotherapeutic interventions with strongest support to address suicidality include dialectical behavior therapy, cognitive behavior therapy and mentalization-based therapies. • Ketamine has no evidence to help with suicidality and may increase suicide in some instances. OBSERVABLE WARNING SIGNS THAT ARE HIGH RISK FACTORS: Each patient is unique and a comprehensive assessment of risk factors helps identify the level of intervention needed. Intervention can vary from outpatient treatment to inpatient treatment and assessment helps identify the level of treatment needed. Certain warning signs are higher risk and stated below. • Seeking means to kill oneself, non-suicidal self-injurious behavior and suicide attempts. • Hopelessness, purposelessness, not belonging. • Expressions of anger, mood, recklessness. • Withdrawal from activities. • Seeking out internet sites on how to commit suicide.
M E D I C I N E . O K S T A T E . E D U
109
