Why is it Important to Implement Youth Suicide Prevention in Clinical Settings?

Suicide is the second leading cause of death in youth and young adults, ages 10-24 years

Medical settings are well-positioned to prevent and treat illness and save lives. Over a quarter of deaths in young people 10-24 years of age are from suicide, a potentially preventable outcome.

Data from the 2019 Youth Risk Behavior Survey indicate that:

• 8% of high school students reported “seriously considering” suicide
• 9% of high school students attempted suicide within the past year

Moreover, data from the 2019 CDC death reports reveal that in 2019:

• 6,488 children, adolescents, and young adults died by suicide
• Out of the 32,935 youth deaths, 20% were from suicide
• Every day, approximately 18 youth died by suicide

Clinical settings are well-positioned to identify and treat suicide risk

Many young people that die by suicide visit a healthcare provider in the months or weeks, prior to their death:

• 80% of adolescents visited a healthcare provider within the year prior to death by suicide
• 49% of youth had visited an emergency department (ED) within the year before their death
• 38% of adolescents had contact with a healthcare system within the 4 weeks before their death
• 34% of people ages 15+ years had contact with a healthcare provider in the week before their death

Most young people keep suicidal thoughts to themselves and do not bring up the topic on their own:

• Youth at risk for suicide may present to the clinic with somatic complaints; physical symptoms are often easier to talk about than mental health concerns
• Screening can open a potentially life-saving discussion about suicidal thoughts. Unfortunately, most youth who are thinking about suicide pass through the healthcare system with their suicide risk unrecognized because they were not asked directly about suicidal thoughts and behaviors

Protecting Youth Mental Health: The US Surgeon General’s Advisory

The 2021 US Surgeon General’s Advisory, Protecting Youth Mental Health highlights that mental health is inseparable from overall health. Therefore, suicide prevention is part of overall health promotion.

In clinical practice, efforts to promote health and prevent suicide can include encouraging physical activity, healthy sleeping/eating habits, positive communication, strong peer/family relationships, and developmentally appropriate problem-solving strategies. Importantly, building trusting relationships and providing trauma-informed care to patients and families can help to support healthy mental health development.

The Surgeon General’s Advisory notes that clinical treatment is a critical part of the broader public health approach to protecting mental health, and includes:

• Risk identification, screening, and assessment
• Indicated interventions (eg, safety planning and lethal means counseling for youth with suicidal ideation or behavior)
• Treatment (eg, use of medications, more frequent visits, or referral to cognitive behavioral therapy or other evidence-based suicide risk reducing treatment)
• Recovery (eg, supporting individuals to maintain progress, encouraging post-traumatic growth, facilitating individuals to find meaning and purpose)

Pediatric clinicians are encountering suicidal ideation, behavior, and death in their patient populations

Data from the 2019 AAP Periodic Survey of Fellows indicate:

• 92% of pediatricians have had a patient disclose suicidal ideation
• 80% of pediatricians have had a patient attempt or die by suicide
• 48% of pediatricians reported that they had a patient attempt or die by suicide in the past year

In 2021, AAP partnered with the American Academy of Child and Adolescent Psychiatry (AACAP) and Children’s Hospital Association (CHA) to declare a national emergency in child and adolescent mental health.

In a response to these concerning trends, this section of the Blueprint presents strategies for identifying youth at risk of suicide and providing appropriate supports in clinical practice settings. All you need to implement these strategies is the vision to save lives, a clinician champion, tools to identify suicide risk, guidelines to manage patients that screen positive, and motivation.