Wasserman Danuta, Carli Vladimir, Iosue Miriam, Javed Afzal, Herrman Helen
National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden.
Section on Suicidology, World Psychiatric Association (WPA), Geneva, Switzerland.
Asia Pac Psychiatry. 2021 Sep;13(3):e12452. doi: 10.1111/appy.12452. Epub 2021 Mar 1.
Suicide is a global mental health problem for people of all ages. While rates of suicide in children and adolescents are reported as lower than those in older populations worldwide, they represent the third leading cause of death in 15-19-year-olds. The rates are higher among boys than girls worldwide, though the death rates for girls exceed those for boys in Bangladesh, China, India, and Nepal. There has been a general decrease in adolescent suicide rates over recent decades. However, increases are reported in South East Asia as well as South America over the same time period.
A narrative review method has been used to summarize current knowledge about risk and protective factors for suicide among children and adolescents and to discuss evidence-based strategy for suicide prevention in this age group.
Identified suicide risk and protective factors for children and adolescents largely overlap with those for adults. Nevertheless, developmental characteristics may strengthen the impact of some factors, such as decision-making style, coping strategies, family and peer relationships, and victimization. The implementation of evidence-based suicide preventive strategies is needed. Restricting access to lethal means, school-based awareness and skill training programs, and interventions delivered in clinical and community settings have been proven effective. The effectiveness of gatekeeper training and screening programs in reducing suicidal ideation and behavior is unproven but widely examined in selected settings.
Since most studies have been conducted in western countries, future research should assess the effectiveness of these promising strategies in different cultural contexts. The use of more rigorous study designs, the use of both short- and long-term follow-up evaluations, the larger inclusion of individuals belonging to vulnerable groups, the evaluation of online intervention, and the analysis of programs' cost-effectiveness are also required.
自杀是一个影响所有年龄段人群的全球性心理健康问题。虽然据报告，全球儿童和青少年的自杀率低于老年人群体，但自杀却是15至19岁青少年的第三大死因。全球范围内男孩的自杀率高于女孩，不过在孟加拉国、中国、印度和尼泊尔，女孩的死亡率超过男孩。近几十年来，青少年自杀率总体呈下降趋势。然而，同期东南亚和南美洲的自杀率却有所上升。
采用叙述性综述方法，总结当前关于儿童和青少年自杀风险及保护因素的知识，并讨论该年龄组基于证据的自杀预防策略。
已确定的儿童和青少年自杀风险及保护因素在很大程度上与成年人的相同。然而，发育特征可能会强化某些因素的影响，如决策方式、应对策略、家庭和同伴关系以及受侵害情况。需要实施基于证据的自杀预防策略。限制获取致命手段、开展基于学校的意识和技能培训项目，以及在临床和社区环境中进行干预已被证明是有效的。守门人培训和筛查项目在减少自杀意念和行为方面的有效性未经证实，但在特定环境中得到了广泛研究。
由于大多数研究是在西方国家进行的，未来的研究应评估这些有前景的策略在不同文化背景下的有效性。还需要采用更严谨的研究设计，同时进行短期和长期随访评估，更多纳入弱势群体个体，评估在线干预，以及分析项目的成本效益。
