Jacobsen L K, Rabinowitz I, Popper M S, Solomon R J, Sokol M S, Pfeffer C R
New York Hospital-Westchester Division, White Plains 10605.
J Am Acad Child Adolesc Psychiatry. 1994 May;33(4):439-52. doi: 10.1097/00004583-199405000-00001.
Much of the literature on assessment of suicidal children has focused on identifying risk factors associated with suicidal ideation and behavior in this population. Unique problems encountered in interviewing prepubertal children about suicidal ideation and behavior are examined in this paper.
Observations of problems encountered in interviewing prepubertal children about suicidal ideation and behavior were gleaned in the context of interviews of children admitted to a child psychiatry inpatient unit and interviews of the parents of these children.
Unique problems include difficulties in assessment of suicidal intent, impact of cognitive development, particularly of the concept of death, interaction between current emotional state and memory of previous suicidal episodes, characteristics of play associated with suicidal states, effects of parents' attitudes toward assessment on information gathering, and the impact of certain risk factors on cognition and behavior during the interview.
Interviewing children about suicidal ideation and behavior necessitates that the clinician attend to multiple elements of the interview simultaneously. These interviews are further complicated by the stressful thoughts and feelings that can be raised in both clinician and child in reaction to exploring the child's suicidal ideation and behavior. Additional research is needed to refine the process of reliable interviewing of children about suicidal ideation and behavior and to develop instruments both to quantitate the different elements of these interviews and to guide the clinicians conducting them.
关于自杀儿童评估的许多文献都集中在识别该人群中与自杀意念和行为相关的风险因素。本文探讨了在询问青春期前儿童自杀意念和行为时遇到的独特问题。
在对儿童精神病住院部收治的儿童进行访谈以及对这些儿童的父母进行访谈的过程中，收集了在询问青春期前儿童自杀意念和行为时遇到问题的观察结果。
独特问题包括自杀意图评估困难、认知发展的影响，尤其是对死亡概念的影响、当前情绪状态与既往自杀事件记忆之间的相互作用、与自杀状态相关的游戏特征、父母对评估的态度对信息收集的影响，以及某些风险因素对访谈期间认知和行为的影响。
询问儿童自杀意念和行为要求临床医生同时关注访谈的多个要素。由于在探索儿童自杀意念和行为时，临床医生和儿童都会产生压力性的想法和感受，这些访谈会进一步复杂化。需要进行更多研究来完善对儿童自杀意念和行为进行可靠访谈的过程，并开发工具来量化这些访谈的不同要素并指导进行访谈的临床医生。
