Preventing the suicidal behaviour in children and adolescents (SS030 Section Symposium)

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Preventing the suicidal behaviour in children and
adolescents(SS030 Section Symposium)

• J.L. Pedreira Massa
• Niños Jesús University Childrens Hospital
• Autonomous University of Madrid
• G. Lahera
• University Hospital Príncipe de Asturias.
  University of Alcalá de Henares (Madrid)

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Operational criteria Suicide/1

• Definition
• Fatal outcome
• Self-initiation of act that leads to this outcome
• Knowledge of actor that action he iniciates to
  produce the objective state of death

• Considerations
• Intent to die not necessary
• Fatl outcome short term effect of act
• Terminal condition does not exclude suicide

Rene F.W. Diekstra. WHO-Europe (1992)
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Operational criteria Suicide/2

• Inclusion
• Evidence of knowledge has to be available
• Terrorist suicide and drug overdose in addicts

• Exclusion
• Grandiose-megalomaniac acting-out in psychosis
• Suicidal erosion (to be scored as Including
  Self Mutilation Disorder)

Rene F.W. Diekstra. WHO-Europe (1992)
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Operational criteria Attempted Suicide/1

• Definition
• Non-fatal outcome
• Self-initiation of act that would have led to
  fatal outcome if not for...
• Knowledge or expectation of actor that action he
  iniciates tends to produce the objective state of
  death

• Considerations
• Intent to die not necessary
• Fatl outcome short term effect of act
• Terminal condition does not exclude suicide
• Medical seriousness not decisive
• Conditions to be formulated per method

Rene F.W. Diekstra. WHO-Europe (1992)
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Operational criteria Attempted Suicide/2

• Inclusion
• Evidence of knowledge has to be available
• Terrorist attempt and drug overdose in
  addicts
• Nonhabitual alcohol overdose

• Exclusion
• Grandiose-megalomaniac acting-out in psychosis
• Suicidal erosion (to be scored as Including
  Self Mutilation Disorder)
• Habitual act

Rene F.W. Diekstra. WHO-Europe (1992)
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Operational criteria Parasuicide/1

• Definition
• Non-fatal outcome
• Self-initiation of act that leads to selfharm or
  ingestion af a substance in excess of the
  generally recognized therapeutic dosage (or will
  do so if not for....)
• Knowledge of actor that action he iniciates tends
  to produce objective selfharm or overdosage of
  substance

Rene F.W. Diekstra. WHO-Europe (1992)
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Operational criteria Parasuicide/2

• Inclusion
• Manipulative acts, conditions to be formulated
  per method
• Cluster of parasuicidal acts
• Acute alcohol intoxication
• Evidence of knowledge has to be available
  specific motive irrelevant (e.g. Wanting to sleep)

• Exclusion
• Habitual Behaviour (Including Self Mutilation
  Disorder)

Rene F.W. Diekstra. WHO-Europe (1992)
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Pathways to suicidal behaviour Prescriptions for
psychosocial prevention in adolescence
Precipitant (e.g. bullying)
Inability to influence others
Cognitive distorsion
Lack of assertiveness
Intense affect/pooraffect regulation
Impulsive decision making Inability to generate
other alternatives Inability to evaluate
consequences of actions
D.A. Brent D.J. Kolko (1990). Modified by J.L.
Pedreira (1995)
Suicidal behaviour
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Summary of factors influencing suicidal behaviour
Overgeneral retrieval style
Reduced anticipation of future pleasurable
experiences
Poor problem solving
Unsatisfactory interpersonal context
Focus on limited sources of happiness
Suicidal behaviour
Personality factors
Continued inability to resolve current problems
Negative life events
A.K. MacLeod J.M.G. Williams.WHO-Europe (1992)
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Screening for youth at risk for suicide/1
Psychiatric difficulties Depression Some
psychiatric treatments (e.g. SSRI) Substance
abuse Conduct problems Psychosis Past suicidal
threats/attempts
D.A. Brent D.J. Kolko (1990). Modified by J.L.
Pedreira (1998)
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Screening for youth at risk for suicide/2
Poor social adjustment School failure/dropout Bul
lying Legal problems Social isolation Interperson
al conflict
D.A. Brent D.J. Kolko (1990). Modified by J.L.
Pedreira (1998)
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Screening for youth at risk for suicide/3
Family/environment Interpersonal
loss Bullying Family problems Abuse/neglect
Family violence Family history psychiatric
disorder or suicide Exposure to suicide (in those
already psychiatrically vulnerable)
D.A. Brent D.J. Kolko (1990). Modified by J.L.
Pedreira (1998)
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Conclusions/1

• Suicide in Adolescence is a serious international
  public health problem
• Suicide and attempered suicide can be prevented,
  but the development, implementation and
  evaluation of effective large-scale prevention
  programs is still in its infancy
• The organizational structures required for
  well-coordinated programs of research and
  practice in the area of suicide prevention are
  only beginning
• Adequate training of health care professionals
  and other relevant groups in the assessment and
  management of suicide risk is lacking

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Conclusions/2

• The WHO-Europe group have formulated
  comprehensive strategies for the prevention of
  suicide
• The design and implementation of national
  research progams
• The improvement of services for health care and
  specific mental health care in adolescnets
• The provision of information and training on
  suicide prevention to relevant professional
  groups, organizations and the general public
• Formulation of strategies and techniques to deal
  with special risk groups