Methods: We reviewed consecutive adolescent psychiatric emergency room assessments over a 4-year time period conducted at Children’s Hospital, Boston, a large tertiary care pediatric hospital, for the chief complaint of suicidality. We broadly defined suicidality as ideation, intent, plans, attempts, and other self-injurious behaviors. We ascertained how the patient communicated their suicidality, and to whom, and we obtained demographic and other pertinent clinical information.
Results: There were a total of 1,350 psychiatric evaluations done at Children’s Hospital, Boston for the chief complaint of suicidality during the study period. The vast majority (n = 1260) of patients communicated their suicidality verbally or via witnessed gesture. There were 54 who communicated suicidality via a hand-written note and 36 who communicated suicidality via electronic means. Patients in our comparison groups were demographically and clinically similar. One striking difference was to whom each group communicated their distress. Of those who communicated electronically, the majority, 67%, did so to a peer and only 33% to an adult, whereas those who communicated via written notes were more likely to do so to an adult. In the written note group, 7% communicated to a peer and 93% to an adult. Not surprisingly, the numbers of electronic communications of suicidality increased over the four-year study period from 2005 to 2009.
Conclusions: The increasing use of technology for communication among adolescents may mean that a peer is the first recipient of a ‘distress call’. Therefore, differential patterns of communication among adolescents with suicidality may have implications for their clinical management and the timely provision of needed services. Our findings also point to the importance of taking a media use history, particularly for adolescent patients who are high media users, and psychoeducational prevention programs in schools concerning appropriate responses to such calls. Replication is needed using prospective designs to conduct systematic inquiry about modes of communication used by suicidal adolescents.