Assessing Suicide Risk in Children: Guidelines for Developmentally Appropriate Interviewing

INTRODUCTION

  • Suicide as a Leading Cause of Death

    • Suicide considered a leading cause of death across all age groups in the U.S. (National Institute of Mental Health [NIMH], 2003).

    • Accounts for approximately 5.8% of deaths in 10-14-year-olds (Gould, Shaffer, & Greenberg, 2003).

    • Ranks between the 3rd and 7th leading cause of death among 5-14 year-olds (American Association of Suicidology [AAS], 2006; Wise & Spengler, 1997).

    • Prevalence of completed suicide among children is low compared to other age groups (AAS, 2003).

    • Suicidal thoughts and behaviors in children are reportedly common (Brent & Kolko, 1990; Klimes-Dougan, 1998).

    • AAS (2006) reported that youth make approximately 100-200 suicide attempts for each completed suicide.

CHALLENGES IN ASSESSING SUICIDE RISK IN CHILDREN

  • Clinician's Discomfort

    • Many mental health counselors feel discomfort in discussing suicide with children (Shea, 1999).

    • This discomfort may be exacerbated by myths and misconceptions about childhood suicide (Wise & Spengler, 1997).

    • Prevalence of suicidal behavior in children is often underestimated due to statistical classification errors and adults' disbelief that children can plan and attempt suicide (Stefanowski-Harding, 1990).

  • Need for Preparedness

    • Despite discomfort, mental health counselors must be prepared to assess child suicide and intervene (Hendren, 1990; Juhnke, 1996; Stefanowski-Harding; Wise & Spengler).

    • Information regarding suicide risk in children is often scattered across disciplines, making comprehensive understanding challenging.

RISK FACTORS FOR SUICIDE IN CHILDREN

  • Theoretical Models

    • Various theoretical and conceptual models exist to guide understanding of suicide risk factors (Berman, Jobes, & Silverman, 2006; Stillion & McDowell 1996; Westefeld et al., 2000).

    • Emphasis on theoretical integration, particularly in psychological theories (Berman et al.).

  • Suicide Trajectory Model

    • Stillion and McDowell proposed a multidimensional model to explore risk factors and events leading to suicidal ideation and behavior.

RISK FACTORS IN DETAIL

Biological Risk Factors

  • Impulsivity as a significant factor leading to more spontaneous suicide attempts (Stillion & McDowell, 1996).

  • Sex and age impact suicide risk; differences emerge at age 10 (Wise & Spengler, 1997).

  • Suicide rates increase as children age; very low among very young children.

Psychological Risk Factors

  • Feelings of inferiority and “expendable child syndrome” (Stillion & McDowell, 1996).

  • Common symptoms include depression, anxiety, aggression, impulsivity.

  • Psychological disturbances are prevalent among children at risk for suicide (Brent & Kolko, 1990; Gould et al., 2003; Weller et al., 2001; Wise & Spengler, 1997).

Cognitive Risk Factors

  • Immature views of death, concrete thinking styles, and attraction/repulsion to life and death (Stillion & McDowell, 1996).

  • Loss of rational thinking linked to drug/alcohol use and hallucinations (Juhnke, 1996; Pfeffer, 2003).

Environmental Risk Factors

  • Exposure to early loss, parental conflict, chaotic family structures, abuse, neglect (Stillion & McDowell, 1996).

  • Mental health issues in parents significantly increase child risk (Brent & Kolko; Gould et al.; Stefanowski-Harding; Stillion & McDowell; Weller et al., 2001).

  • Children at risk for suicide often have poor social skills, feel isolated from peers, and face academic challenges (Stefanowski-Harding, 1990; Wise & Spengler, 1997).

Precipitating Events

  • Recent stressors such as family crises, health problems, or exposure to suicide greatly increase risk (Gould et al., 2003; Roberts, 2000; Stillion & McDowell, 1996).

  • Prior suicidal ideation and attempts are predictive of future behavior (Gould et al.; Juhnke, 1996; Weller et al.; Wise & Spengler).

PREPARING FOR SUICIDE ASSESSMENT IN CHILDREN

  • Mental health counselors must reflect on their feelings and fears about conducting suicide assessments (Shea, 1999).

  • Proper preparation minimizes the possibility of denying the seriousness of situations or acting based on misinformation (Stefanowski-Harding, 1990).

  • Adaptation of questions to various developmental levels is recommended.

  • Consider available information about the child to better align with their communicative capabilities.

GUIDELINES FOR DEVELOPMENTALLY APPROPRIATE INTERVIEWING

  • Initial Engagement

    • Start by greeting the child and caregivers, engaging them in light conversation to establish rapport.

    • Clearly communicate the purpose of the interview, ensuring the child feels safe and understands they are not in trouble.

  • Assessment Process

    • Utilize open-ended questions to encourage narratives of the child's feelings and experiences (Aldridge & Wood, 1998; Bourg et al., 1999).

    • Assess for risk factors and suicidal ideation using developmentally appropriate language.

  • Addressing Feelings

    • Reflective listening and empathetic responses are critical for comfort during assessments (Murphy & Dillon, 2003; Jobes et al., 2000; Roberts, 2000).

CRISIS INTERVENTION AND PLANNING

  • Generating Alternatives

    • Engage caregivers in action planning, assessing their perceptions and ensuring their willingness to provide necessary support (Jobes et al., 2000).

    • Develop a follow-up plan, considering 24-hour crisis services and potential inpatient hospitalization if needed.

CONCLUSION

  • Understanding suicidal behavior in children is crucial for mental health counselors.

  • Education on risk factors, beliefs, and personal discomfort are essential for competent assessments and interventions.