Asarnow Joan Rosenbaum, Mehlum Lars
Department of Psychiatry and Behavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA (Asarnow); National Centre for Suicide Research and Prevention, University of Oslo, Oslo, Norway (Mehlum).
Focus (Am Psychiatr Publ). 2023 Apr;21(2):209-216. doi: 10.1176/appi.focus.23021005. Epub 2023 Apr 14.
Suicide is a leading cause of death globally in youths, and suicidal behavior and self-harm are major clinical concerns. This article updates the previous practitioner review (2012) with the aims of integrating new research evidence, including that reported in this Special Issue.
The article reviews scientific evidence related to steps in the care pathway for identifying and treating youths with elevated suicide/self-harm risk, specifically: (a) screening and risk assessment; (b) treatment; and (c) community-level suicide prevention strategies.
Review of current evidence indicates that major advances have been achieved in knowledge regarding clinical and preventive practices for reducing suicide and self-harm risk in adolescents. The evidence supports the value of brief screeners for identifying youths with elevated suicide/self-harm risk and the efficacy of some treatments for suicidal and self-harm behavior. Dialectical behavior therapy currently meets Level 1 criteria (2 independent trials supporting efficacy) as the first well-established treatment for self-harm, and other approaches have shown efficacy in single randomized controlled trials. The effectiveness of some community-based suicide prevention strategies for reducing suicide mortality and suicide attempt rates has been demonstrated.
Current evidence can guide practitioners in delivering effective care for youth suicide/self-harm risk. Treatments and preventive interventions that address the psychosocial environment and enhance the ability of trusted adults to protect and support youths, while also addressing the psychological needs of youths appear to yield the greatest benefits. Although additional research is needed, our current challenge is to do our best to effectively utilize new knowledge to improve care and outcomes in our communities.Reprinted from , with permission from John Wiley and Sons. Copyright © 2019.
自杀是全球青少年死亡的主要原因之一，自杀行为和自我伤害是主要的临床关注点。本文更新了之前的从业者综述（2012年），旨在整合新的研究证据，包括本期特刊中报道的证据。
本文回顾了与识别和治疗自杀/自我伤害风险升高的青少年的护理路径中的步骤相关的科学证据，具体包括：（a）筛查和风险评估；（b）治疗；（c）社区层面的自杀预防策略。
对当前证据的回顾表明，在降低青少年自杀和自我伤害风险的临床和预防实践知识方面已取得重大进展。证据支持简短筛查工具对于识别自杀/自我伤害风险升高的青少年的价值，以及某些治疗对自杀和自我伤害行为的有效性。辩证行为疗法目前符合一级标准（两项独立试验支持其疗效），是首个公认的有效治疗自我伤害的方法，其他方法在单组随机对照试验中也显示出疗效。一些基于社区的自杀预防策略在降低自杀死亡率和自杀未遂率方面的有效性已得到证实。
当前证据可为从业者为青少年自杀/自我伤害风险提供有效护理提供指导。解决心理社会环境并增强可信赖成年人保护和支持青少年的能力，同时满足青少年心理需求的治疗和预防干预措施似乎能带来最大益处。尽管还需要更多研究，但我们当前面临的挑战是尽最大努力有效利用新知识，以改善我们社区的护理和结果。转载自 ，经约翰威立父子公司许可。版权所有©2019。
