Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité University Medical Center, Berlin; The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA;Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine,Hempstead, NY, USA; The Feinstein Institute for Medical Research, Center for PsychiatricNeuroscience, Manhasset, NY, USA.
Dtsch Arztebl Int. 2020 Apr 10;117(15):261-267. doi: 10.3238/arztebl.2020.0261.
The suicide of minors in Germany is rare in absolute numbers: there were only 212 suicides among persons aged 10 to 20 in Germany in 2017. Nonetheless, in school surveys, 36.4-39.4% of those surveyed reported suicidal ideation, and 6.5-9% reported suicide attempts. Suicide among children and adolescents is thus a clinically and societally relevant problem.
This review is based on pertinent articles retrieved by a selective literature search in the PubMed and PsycInfo databases (April 2019) employing the search terms "suicidality," "suicidal*," and "suicide," and on further information from several textbooks (1991-2017).
In children and adolescents with a mental illness, the risk of suicide is higher by a factor of 3 to 12. Mobbing experiences increase the suicide risk as well (odds ratio [OR] = 2.21, p <0.05). Non-suicidal self-injurious behavior (NSSB) is also a risk factor for both suicidal ideation (OR = 2.95) and suicide attempts (hazard ratio [HR] = 2.00). Intoxication with medications is the most common method of attempted suicide (67.7%). Most suicides are preceded by early warning signs. Psychiatric hospitalization is indicated for children and adolescents who are in acute danger of doing harm to themselves. Specific types of treatment, family-centered methods in particular, have been found to lessen the frequency of suicidal ideation and suicide attempts. The administration of antidepressant drugs to children and adolescents is controversial, as there is evidence of increased suicidality (but not mortality) for single medications. Antidepressant drugs should not, however, be withheld for this reason, if indicated. The prerequisite in all cases is close observation.
To prevent suicide and improve outcomes, risk factors for suicide must be considered, and the indications for primary and secondary preventive and therapeutic measures must be established. Online therapeutic modalities may become more widely used in the near future, particularly among young patients, who are well versed in the use of the Internet.
从绝对数字来看，德国未成年人自杀的情况较为罕见：2017 年，德国 10 至 20 岁人群中仅有 212 人自杀。尽管如此，在学校调查中，36.4%-39.4%的调查对象报告有自杀意念，6.5%-9%的调查对象报告有自杀企图。因此，儿童和青少年自杀是一个具有临床和社会意义的问题。
本综述基于在 PubMed 和 PsycInfo 数据库中进行的选择性文献检索中检索到的相关文章（2019 年 4 月），使用的检索词为“自杀倾向”、“自杀意念”和“自杀”，并参考了几本教科书（1991-2017 年）的信息。
患有精神疾病的儿童和青少年自杀风险高 3 至 12 倍。欺凌经历也会增加自杀风险（优势比[OR] = 2.21，p <0.05）。非自杀性自伤行为（NSSB）也是自杀意念（OR = 2.95）和自杀企图（危险比[HR] = 2.00）的一个危险因素。药物中毒是自杀企图最常见的方法（67.7%）。大多数自杀行为都有早期预警信号。对于有自残风险的儿童和青少年，应进行住院治疗。已发现特定类型的治疗方法，特别是以家庭为中心的方法，可以减少自杀意念和自杀企图的发生频率。抗抑郁药的使用在儿童和青少年中存在争议，因为单一药物的自杀意念（而非死亡率）会增加。然而，如果有治疗指征，不应因此而拒绝使用抗抑郁药。所有情况下的前提都是密切观察。
为了预防自杀并改善预后，必须考虑自杀风险因素，并确定初级和二级预防及治疗措施的指征。在线治疗模式可能在不久的将来得到更广泛的应用，尤其是在精通互联网使用的年轻患者中。
