The increased risk of suicide in young girls

Is Your Child or Teen Suicidal?The increased risk of suicide in young girls presents problems forprevention efforts. In the past, when three out of four suicides were male,suicide prevention focused on boys and young men. Prevention efforts alsofocused on firearms, which had been the most common method of suicide.The September issue of the Journal of Pediatrics carries an updatedreview of teen suicide by Benjamin N. ShainMD, PhD, of the American Academyof Child and Adolescent Psychiatry, and colleagues from the American Academy ofPediatrics committee on adolescence.”Unfortunately, no one can accurately predict suicide, so even expertscan only determine who is at high risk,” Shain and colleagues note.Examples of high-risk teens include:• Teens with a plan or recent attempt to commit suicide• Teens who say they are going to kill themselves• Teens who talk about killing themselves and who become agitated orhopeless• Impulsive teens who become profoundly sad and who suffer conditions such asbipolar disorder, major depression, psychosis, or substance use disorders Signs of major depression include:• Cranky mood• Preoccupation with song lyrics suggesting life is meaningless• Loss of interest in sports and usual activities• Failure to gain normal weight• Frequent complaints of physical illness such as headache and stomachache• Excessive late-night TV watching• Refusal to wake for school in the morning• Talk of running away from home, or attempts to do so• Persistent boredom• Oppositional and/or negative behavior• Poor performance in school or frequent school absences• Recurrent talk of or writing about suicide• Giving away toys or belongingsSigns Not Always ObviousUnfortunately, absence of high risk does not necessarily mean low risk. Kidswho seem to be at low risk, but who joke about killing themselves or whorepeatedly seek treatment for physical complaints, “may be asking for helpthe only way they can,”Any teen who suffers significant loss of function or distress due toemotional or behavioral symptoms should be closely observed, referred for amental health evaluation, or both.A brief psychological intervention may be all teens need if they have aresponsive and intact family, good relationships with their peers, hope for thefuture, and a desire to resolve conflicts.Hospitalization and long-term psychiatric care may be needed for teenswho:• Have made previous suicide attempts• Show a strong intent to commit suicide• Have serious depression or other major psychiatric disorders• Abuse alcohol or drugs• Have low impulse control If a teen has made a suicide attempt, it’s crucial to keep up continuouspsychological care after hospital discharge. It’s important to continuetreatment of underlying psychiatric illnesses, to remove and to lock up potentially lethal medications. Getting the teen to agree to a “no suicide” contract has not been proven effective.