Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Int Rev Psychiatry. 2020 May;32(3):254-264. doi: 10.1080/09540261.2019.1693351. Epub 2020 Jan 10.
The number of children and adolescents dying by suicide is increasing over time. Patterns for who is at risk are also changing, leading to a need to review clinical suicide prevention progress and identify limitations with existing practices and research that can help us further address this growing problem. This paper aims to synthesise the literature on paediatric suicide screening, risk assessment and treatment to inform clinical practice and suicide prevention efforts. Our review shows that universal screening is strongly recommended, feasible and acceptable, and that there are screening tools that have been validated with youth. However, screening may not accurately identify those at risk of dying due to the relative rarity of suicide death and the associated research and clinical challenges in studying such a rare event and predicting future behaviour. Similarly, while risk assessments have been developed and tested in some populations, there is limited research on their validity and challenges with their implementation. Several promising suicide-specific treatments have been developed for youth, but overall there is an insufficient number of randomised trials. Despite great need, the research evidence to support screening, risk assessment and treatment is still limited. As suicide rates increase for children and adolescents, continued research in all three domains is needed to reverse this trend.
儿童和青少年自杀的人数在不断增加。谁有自杀风险的模式也在发生变化，这导致我们需要重新审视临床预防自杀的进展，并确定现有实践和研究中的局限性，以帮助我们进一步解决这一日益严重的问题。本文旨在综合儿童自杀筛查、风险评估和治疗方面的文献，为临床实践和预防自杀工作提供信息。我们的综述表明，普遍筛查是强烈推荐的、可行的和可接受的，并且已经有了经过青年群体验证的筛查工具。然而，由于自杀死亡相对罕见，以及研究如此罕见事件和预测未来行为的相关研究和临床挑战，筛查可能无法准确识别那些有死亡风险的人。同样，虽然已经在一些人群中开发和测试了风险评估，但它们的有效性以及实施方面的挑战方面的研究有限。已经为青少年开发了几种有前途的专门针对自杀的治疗方法，但总的来说，随机试验的数量仍然不足。尽管有巨大的需求，但支持筛查、风险评估和治疗的研究证据仍然有限。随着儿童和青少年的自杀率不断上升，在这三个领域都需要继续进行研究，以扭转这一趋势。
