Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and.
Pediatrics. 2019 Feb;143(2). doi: 10.1542/peds.2018-1771. Epub 2019 Jan 14.
: media-1vid110.1542/5972300121001PEDS-VA_2018-1771 OBJECTIVES: To examine agreement between parent and adolescent reports of adolescents' suicidal thoughts and explore demographic and clinical factors associated with agreement in a large community sample.
Participants included 5137 adolescents 11 to 17 years old (52.1% girls; 43.0% racial minority) and a collateral informant (97.2% parent or stepparent) from the Philadelphia Neurodevelopmental Cohort. Families were recruited from a large pediatric health care network. Adolescents and parents completed a clinical interview that included questions about adolescents' lifetime suicidal thoughts.
Agreement was moderate for thoughts of killing self (κ = 0.466) and low for thoughts of death or dying (κ = 0.171). Discrepancies stemmed from both parental unawareness of suicidal thoughts reported by adolescents and adolescent denial of suicidal thoughts reported by parents. Fifty percent of parents were unaware of adolescents' thoughts of killing themselves, and 75.6% of parents were unaware of adolescents' recurrent thoughts of death. Forty-eight percent of adolescents denied thoughts of killing themselves, and 67.5% of adolescents denied thoughts of death reported by parents. Several demographic (eg, age) and clinical (eg, treatment history) characteristics were associated with agreement.
Early identification and intervention hinge on reliable and valid assessment of suicide risk. The high prevalence of parental unawareness and adolescent denial of suicidal thoughts found in this study suggests that many adolescents at risk for suicide may go undetected. These findings have important clinical implications for pediatric settings, including the need for a multi-informant approach to suicide screening and a personalized approach to assessment based on empirically derived risk factors for unawareness and denial.
媒体-1vid110.1542/5972300121001PEDS-VA_2018-1771 目的：检查父母和青少年报告青少年自杀念头之间的一致性，并在大型社区样本中探讨与一致性相关的人口统计学和临床因素。
参与者包括来自费城神经发育队列的 5137 名 11 至 17 岁的青少年（52.1%为女孩；43.0%为少数民族）和一名间接报告者（97.2%为父母或继父/母）。这些家庭是从一家大型儿科保健网络中招募的。青少年和父母完成了一项临床访谈，其中包括有关青少年一生自杀念头的问题。
对于自杀念头（κ=0.466）的一致性中等，对于死亡或垂死念头（κ=0.171）的一致性较低。差异源于父母对青少年报告的自杀念头的无意识以及青少年对父母报告的自杀念头的否认。50%的父母不知道青少年有自杀的想法，75.6%的父母不知道青少年有反复想死的念头。48%的青少年否认有自杀念头，67.5%的青少年否认父母报告的死亡念头。一些人口统计学（例如，年龄）和临床（例如，治疗史）特征与一致性相关。
早期识别和干预取决于对自杀风险的可靠和有效的评估。本研究发现，父母普遍不知道青少年有自杀念头，青少年否认父母报告的自杀念头，这表明许多有自杀风险的青少年可能未被发现。这些发现对儿科环境具有重要的临床意义，包括需要采用多信息源方法进行自杀筛查，并根据对无意识和否认的经验性风险因素制定个性化的评估方法。
