- Have you ever felt so upset you wished you were not alive or wanted to die?
- Have you ever hurt yourself or tried to hurt yourself?
- Have you ever tried to kill yourself?
- Have you ever thought about or tried to commit suicide?
- Have you ever done something you knew was so dangerous that you could get hurt or killed by doing it?
- Previous attempts or thoughts
- How many times have you tried to hurt or kill yourself?
- How did you attempt?
- Did you tell anyone? Who?
- How did [your parents] find out about what happened?
- What happened? Did you have to go to a doctor, hospital, or Emergency Department?
- Have you had any other plans or ways you’ve thought about to end your life?
- What made you stop or want to live?
- Current thoughts
- Do you have thoughts of harming or killing yourself now?
- How would you do it?
- How do you feel about being alive now?
- What do you have to live for right now?
- The child or adolescent must not have a persistent wish to die or plans for self-harm.
- Follow-up for thorough psychiatric evaluation must be assured.
- Proper adult supervision must be in place.
- The evaluator should initiate a discussion about removing lethal means (guns, medications) and expressly recommend their removal from the home.
- It may also be valuable to provide education about other risk factors, such as substance abuse.
- Provide community resources and hotlines and encourage the patient to use them. The American Foundation for Suicide Prevention has useful resources including monitored chat, crisis text lines, and a prevention lifeline that can be accessed through the website.
- Lithium has been shown to decrease risk of suicide in adults with bipolar disorder, and may be considered in the therapy of children and adolescents with bipolar disorder and suicidality, though its use entails careful monitoring of blood levels due to its low therapeutic index.
- Tricyclic Antidepressants (TCAs) should not be used as first-line medication for depression in suicidal children and adolescents due to their lethality in overdose and lack of established efficacy in this age group. [AACAP: 2001]
- All medications with approval for use in treatment of depression in children, adolescents, and young adults up to age 25 have an FDA Black Box warning for risk of increasing suicidal thoughts and behaviors. This risk should be disclosed to patients and families, and risks of suicide associated with ongoing untreated or undertreated depression should be weighed with risk of treatment. [Hetrick: 2012] For additional information and discussion, please see Antidepressant Medications and Suicide section of Suicide and Suicide Attempts in Adolescents (AAP).
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|Author:||Thomas G. Conover, MD - 2/2009|
|Reviewing Author:||Mary Steinmann, MD - 4/2017|
|Content Last Updated:||4/2017|
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