Management of Suicidal Adolescents Presenting to the Emergency Department

Author(s): Nizete-Ly Valles*, Dana Billups, Topaz Sampson, Toi Blakley Harris.

Journal Name: Adolescent Psychiatry

Volume 9 , Issue 2 , 2019

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Background: Increasingly, adolescents are presented to hospital emergency departments with suicidal ideation (SI) and depression. Even among those who come in with other complaints, depression and SI are common. Emergency personnel are placed in the default position of providing care for these patients, but often lack sufficient knowledge and skills to do this effectively.

Objective: The aim of this paper is to offer guidance to emergency personnel and describe goals and strategies for screening and brief interventions.

Methods: We review risk factors, assessment tools and evidence-based interventions that can be utilized by mental health professionals working in EDs and by ED staff in the absence of mental health professionals.

Conclusion: Emergency departments can serve a critical role in risk management and treatment of adolescent depression and suicidal ideation. All patients presenting to the ED should be screened for current and past depression and suicidal ideation or attempts. Brief interventions can be delivered in the ED that can increase the likelihood that patients will receive follow- up care.

Keywords: Depression, suicidal ideation, adolescents, emergency management, brief interventions, risk factors.

Adrian, M., Miller, A.B., McCauley, E., and Stoep, A.V. (2016). Suicidal ideation in early to middle adolescence: Sex specific trajectories and predictors. J. Child Psychol. Psychiatry, 57, 645-653.
Alegria, M., Green, J.G., McLaughlin, K.A., Loder, S. (2015). Disparities in child and adolescent mental health and mental health services in the U.S.. William T. Grant Foundation Inequality Paper.
Ali, S., Rosychuk, R.J., Dong, K.A., McGrath, P.J., Newton, A.S. (2012). Temporal trends in pediatric mental health visits: Using longitudinal data to inform emergency department health care planning. Pediatr. Emerg. Care, 28, 620-625.
Asarnow, J.R., Berk, M., Hughes, J.L., Anderson, N.L. (2015). The SAFETY program: A treatment-development trial of a cognitive-behavioral family treatment for adolescent suicide attempters. J. Clin. Child Adolesc. Psychol., 44(1), 194-203.
Asarnow, J.R., Suddath, R., Baraff, L.J., Piacentini, J.C., Berk, M., Rotheram-Borus, M.J. (2011). An emergency department intervention for linking pediatric suicidal patients to follow-up mental health treatment. Psychiatr. Serv., 62, 1303-1309.
Auerbach, R.P., Millner, A.J., Stewart, J.G., Esposito, E. (2015). Identifying differences between depressed adolescent suicide ideators and attempters. J. Affect. Disord., 186, 127-133.
Avenevoli, S., Swendsen, J., He, J.P., Burstein, M., Merikangas, K. (2015). Major depression in the National Comorbidity Survey-Adolescent Supplement: Prevalence, correlates, and treatment. J. Am. Acad. Child Adolesc. Psychiatry, 54, 37-44.
Babeva, K., Hughes, J.L., Asarnow, J. (2016). Emergency department screening for suicide and mental health risk. Child and Adolescent Disorders, 18, 1-12.
Cappelli, M., Gray, C., Zemek, R., Cloutier, P., Kennedy, A., Glennie, E. . . . Lyons, J. S. (2012). The HEADS-ED: A rapid mental health screening tool for pediatric patients in the emergency department. Pediatrics, 130, e321-e327.
Capron, D.W., Allan, N.P., Ialongo, N.S., Leen-Feldner, E., Schmidt, N.B. (2015). The depression distress amplification model in adolescents: A longitudinal examination of anxiety sensitivity cognitive concerns, depression and suicidal ideation. J. Adolesc., 41, 17-24.
Capron, D.W., Fitch, K., Medley, A., Blagg, C., Mallott, M., Joiner, T. (2011). Role of anxiety sensitivity subfactors in suicidal ideation and suicide attempt history. Depress. Anxiety, 29, 195-201.
Centers for Disease Control and Prevention (2015). National Center for Injury Prevention and Controls: Web- Based Injury Statistics Query and Reporting System (WISQARS). 2015. Retrieved from: ncipc/wisqars
Coryell, W., Solomon, D., Leon, A., Fiedorowicz, J.G., Schettler, P., Judd, L. (2009). Does major depressive disorder change with age? Psychol. Med., 39, 1689-1695.
Czyz, E.K., Horwitz, A.G., Arango, A., Cole-Lewis, Y., Berona, J., King, C.A. (2016). Coping with suicidal urges among youth seen in a psychiatric emergency department. Psychiatry Res., 241, 175-181.
Czyz, E.K., King, C.A. (2015). Longitudinal trajectories of suicidal ideation and subsequent suicide attempts among adolescent inpatients. Journal of Child and Adolescent Psychology, 44, 181-193.
Devenish, B., Berk, L., Lewis, A.J. (2016). The treatment of suicidality in adolescents by psychosocial interventions for depression: A systematic literature review. Australian and New Zealand Journal of Psychiatry, 50, 726-740.
Dunn, E.C., McLaughlin, K.A., Slopen, N., Rosand, J., Smoller, J.W. (2013). Developmental timing of child maltreatment and symptoms of depression and suicidal ideation in young adulthood: Results from the National Longitudinal Study of Adolescent Health. Depress. Anxiety, 30, 955-964.
Eisenberg, M.E., Ackard, D.M., Resnick, M.D. (2007). Protective factors and suicide risk in adolescents with a history of sexual abuse. J. Pediatr., 151, 482-487.
Fergusson, D.M., Woodward, L.J., Horwood, L.J. (2000). Risk factors and life processes associated with the onset of suicidal behavior during adolescence and early adulthood. Psychol. Med., 30, 23-39.
Finkelhor, D., Shattuck, A., Turner, H.A., Hamby, S.L. (2014). The lifetime prevalence of child sexual abuse and sexual assault assessed in late adolescence. J. Adolesc. Health, 55, 329-333.
Foley, D.L., Goldston, D.B., Costello, E.J., Angold, A. (2006). Proximal psychiatric risk factors for suicidality in youth—The Great Smoky Mountains study. Arch. Gen. Psychiatry, 63, 1017-1024.
Fordwood, S.R., Asarnow, J.R., Huizar, D.P., Reise, S.P. (2007). Suicide attempts among depressed adolescents in primary care. J. Clin. Child Adolesc. Psychol., 36, 392-404.
Franklin, J.C., Ribeiro, J.D., Fox, K.R., Bentley, K.H., Kleiman, E.M., Huang, X. . . . Nock M. K. (2016). Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychol. Bull., 143(2), 187-232.
Gallagher, M., Prinstein, M.J., Simon, V., Spirito, A. (2014). Social anxiety symptoms and suicidal ideation in a clinical sample of early adolescents: Examining loneliness and social support as longitudinal mediators. J. Abnorm. Child Psychol., 42(6), 871-883.
Gill, P.J., Saunders, N., Gandhi, S., Gonzalez, A., Kurdyak, P., Vigod, S., Guttman, A. (2017). Emergency department as a first contact for mental health problems in children and youth. J. Am. Acad. Child Adolesc. Psychiatry, 56, 475-482.
Gipson, P.Y., Agarwala, P., Opperman, K.J., Horwitz, A., King, C.A. (2016). Columbia-Suicide Severity Scale: Predictive validity with adolescent psychiatric emergency patients. Pediatr. Emerg. Care, 31, 88-94.
Gould, M.S., Greenberg, T., Velting, D.M., Shaffer, D. (2003). Youth suicide risk and preventative interventions: A review of the past 10 years. J. Am. Acad. Child Adolesc. Psychiatry, 42, 386-405.
Holt, M.K., Vivolo-Kantor, A.M., Polanin, J.R., Holland, K.M., DeGue, S., Matjasko, J.L. . . Reid, G. (2015). Bullying and suicidal ideation and behaviors: A meta-analysis. Pediatrics, 135, 1-10.
Horowitz, L.M., Bridge, J.A., Teach, S.J., Ballard, E., Klima, J., Rosenstein, D.L. L., . . . Pao M. (2012). Ask suicide-screening questions (ASQ): A brief instrument for the pediatric emergency department. Arch. Pediatr. Adolesc. Med., 166, 1170-1176.
Hughes, J.L., Anderson, N.L., Wiblin, J.L., Asarnow, J.R. (2017). Predictors and outcomes of psychiatric hospitalization in youth presenting to the emergency department with suicidality. Suicide Life Threat. Behav., 47, 193-204.
Kann, L., McManus, T., Harris, W.A., Shanklin, S.L., Flint, K.H., Hawkins, J. . . .Ethier, K. (2016). Youth risk behavior surveillance—United States, 2015. MMWR Surveill. Summ., 65, 1-118.
Kennebeck, S., Bonin, L. (2017). Suicidal ideation and behavior in children and adolescents: Evaluation and management. In D. Brent & D. Blake (Eds.), UpTo- Date, retrieved from https// contents/suicidal-ideation-and-behavior-in-children-and-adolescents-evaluation-and-management
King, C.A., Gipson, P.Y., Horwitz, A.G., Opperman, K.J. (2015). Teen options for change (TOC): An intervention for adolescent emergency patients who screen positive for suicide risk. Psychiatr. Serv., 66, 97-100.
King, C.A., Jiang, Q., Czyz, E.K., Kerr, D.C.R. (2014). Suicidal ideation of psychiatrically hospitalized adolescents has one-year predictive validity for suicide attempts in girls only. J. Abnorm. Child Psychol., 42, 467-477.
King, C.A., O’Mara, R.M., Hayward, C.N., Cunningham, R. (2009). Adolescent suicide risk screening in the emergency department. Acad. Emerg. Med., 16, 1234-1241.
Kroenke, K., Spitzer, R.I., Williams, J.B. (2001). The PHQ-9: Validity of a brief depression severity of measure. J. Gen. Intern. Med., 16, 606-613.
Lewinsohn, P.M., Rohde, P., Seeley, J.R. (1996). Adolescent suicidal ideation and attempts: Prevalence, risk factors, and clinical implications. Clin. Psychol. Sci. Pract., 3, 25-46.
Mayes, S.D., Calhoun, S.L., Baweja, R., Feldman, L., Syed, E., Gorman, J.M. . . .Siddiqui, F. (2015). Suicide ideation and attempts are associated with co-occurring oppositional defiant disorder and sadness in children and adolescents with ADHD. J. Psychopathol. Behav. Assess., 37, 274-282.
Merikangas, K.R., He, J.P., Burstein, M., Swanson, S.A., Avenevoli, S., Cui, L. . . . Swendson, J. (2010). Lifetime revalence of mental health disorders in U.S. adolescents: results from the National Comorbidity Survey-Adolescent Supplement (NCS-A). J. Am. Acad. Child Adolesc. Psychiatry, 50, 32-45.
Miller, A.B., Esposito-Smythers, C., Weismoore, J.T., Renshaw, K.D. (2013). The relations between child maltreatment and adolescent suicidal behavior: a systematic review and critical examination of the literature. Clin. Child Fam. Psychol. Rev., 16, 146-172.
Miranda, R., Ortin, A., Scott, M., Shaffer, D. (2014). Characteristics of suicidal ideation that predict the transition to future suicide attempts in adolescents. J. Child Psychol. Psychiatry, 55, 1288-1296.
Mojtabai, R., Olfson, M., Han, B. (2016). National trends in the prevalence and treatment of depression in adolescents and young adults. Pediatrics, 138.
Moukaddam, N., Onigu-Otite, E., Tucci, V. (2019). Critical issues in adolescent mental health in the emergency department: Looking beyond triage and risk assessment. Adolesc. Psychiatry, 9(2), 67-68.
Mustanki, B., Andrews, R., Puckett, J.A. (2016). The effects of cumulative victimization on mental health among lesbian, gay, bisexual, and transgender adolescents and young adults. Am. J. Public Health, 106, 527-533.
Nock, M.K., Green, J.G., Hwang, I., McLaughlin, K.A., Sampson, N.A., Zaslavsky, A.M., Kessler, R.C. (2013). Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents. Results from the national comorbidity survey replication adolescent supplement. JAMA Psychiatry, 70, 300-310.
O’Brien, K.H.M., Singer, J.B., LeCloux, M., Duarte-Velez, Y., Spiritio, A. (2014). Acute behavioral interventions and outpatient treatment strategies with suicidal adolescents. Int. J. Behav. Consult. Ther., 9, 19-25.
Panagioti, M., Goodling, P.A., Triantafyllou, K., Tarrier, N. (2015). Suicidality and posttraumatic stress disorder (PTSD) in adolescents: a systemic review and meta-analysis. Soc. Psychiatry Psychiatr. Epidemiol., 50(4), 525-537.
Peralta, A.O., Miranda, R., Polanco-Roman, L., Shaffer, D. (2016). Parent-adolescent acculturation gap and suicidal ideation among adolescents from an emergency department. J. Am. Acad. Child Adolesc. Psychiatry, 55, S250.
Pfeffer, C. (2007). Suicidal behavior in children and adolescents: Causes and management. In Lewis’s Child and Adolescent Psychiatry A Comprehensive Textbook, edited by Martin, A. & Volkmar, F. R., Philadelphia: Lippincott Williams & Wilkins, p. 529-537.
Plemmons, G. (2017). Trends in suicidality and serious self-harm for children 5-17 years at 32 U.S. children’s hospitals, 2008-2015. Presented at the Pediatric Academic Societies Meeting, San Francisco, CA
Rohde, P., Lewinsohn, P.M., Klein, D.N., Seeley, J.R., Gau, J.M. (2013). Key characteristics of major depressive disorder occurring in childhood, adolescence, emerging adulthood, and adulthood. Clin. Psychol. Sci., 1, 41-53.
Rutman, M.S., Shenassa, E., Becker, B. (2008). Brief screening for adolescent depressive symptoms in the emergency department. Acad. Emerg. Med., 15, 17-22.
Schilling, E.A., Aseltine, R.H., Glanovsky, J.L., James, A., Jacobs, D. (2009). Adolescent alcohol use, suicidal ideation, and suicide attempts. J. Adolesc. Health, 44, 335-341.
Stanley, B., Brown, G.K. (2012). Safety planning intervention: A brief intervention to mitigate suicide risk. Cognit. Behav. Pract., 19, 256-264.
Suicide Prevention Resource Center. (2014, September). Suicide screening and assessment. Waltham, MA: Education Development Center, Inc.
Sneed, J.R., Balestri, M., Belfi, B.J. (2003). The use of dialectical behavior therapy strategies in the psychiatric emergency room. Psychotherapy: Theory, Research, Practice, Training, 40, 265-277.
Stanley, I.H., Horowitz, L.M., Bridge, J.A., Wharff, E.A., Pao, M., Teach, S.J. (2016). Bullying and suicide risk among pediatric emergency department patients. Pediatr. Emerg. Care, 32, 347-351.
Stewart, C., Spicer, M., Babl, F.E. (2006). Caring for adolescents with mental health problems: Challenges in the emergency department. J. Paediatr. Child Health, 42, 726-730.
Tang, T.C., Yen, C.F., Cheng, C.P., Yang, P., Chen, C.S., Yang, R.C. . . . Yu. H. S. (2010). Suicide risk and its correlate in adolescents who experienced typhoon-induced mudslides: a structural equation model. Depression and Anxiety, 27, 1143-1148.
Thapar, S., Collishaw, S., Pine, D.S., Thapar, A.K. (2012). Depression in adolescence. Lancet, 379, 1056-1067.
Townsend, C. (2013). Prevalence and consequences of child sexual abuse compared with other childhood experiences. Charleston, SC: Darkness to Light. Retrieved from
Van Eck, K., Ballard, E., Hart, S., Newcomer, A., Musci, R., Flory, K. (2015). ADHD and suicidal ideation: The roles of emotion regulation and depressive symptoms among college students. J. Atten. Disord., 19, 703-714.
Vander Stoep, A., McCauley, E., Flynn, C., Stone, A. (2009). Thoughts of death and suicide in early adolescence. Suicide Life Threat. Behav., 39, 599-613.
Wharff, E.A., Ginnis, K., Ross, A.M. (2012). Family-based crisis intervention with suicidal adolescents in the emergency room: A pilot study. Soc. Work, 57, 133-143.

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Year: 2019
Page: [81 - 91]
Pages: 11
DOI: 10.2174/2210676609666190730094236
Price: $65

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