This issue of Psychiatric Annals focuses on youth suicide. In 2014, suicide was the second leading cause of death among people age 15 to 24 years.1 According to the 2015 Youth Risk Behavior Survey, nearly 17.7% of high school students reported having seriously considered attempting suicide, 14.6% made a suicide plan, 8.6% made a suicide attempt, and 2.8% made an attempt that resulted in injury, poisoning, or overdose that had to be treated by a doctor or nurse.2
Youth suicide became a hot topic in the media in April 2017 with the release and subsequent controversy of the Netflix series 13 Reasons Why, which included a graphic depiction of youth suicide, as well as rape, sexual assault, and bullying. The series portrayed a high school that was unprepared to address many of the risk factors associated with suicide. It was a world devoid of informed or trusted adults, and one that lacked any of the known interventions for suicide risk. The series producers' stated intention was to create a depiction of suicide so awful that no youth would ever want to go through it. Despite the fact that this approach is counter to 40 years of research on media roles and suicide prevention,3 the series inspired many in-person and online conversations about youth suicide. Some of the questions that received widespread attention included:
- Can anything be done in schools to prevent suicide?
- Could someone in an acute suicidal crisis record 12 cassette tapes (and then return from a meeting to record a 13th)?
- How should professionals assess suicide risk, particularly the method?
- What role should parents and adults play in the lives of distressed youth?
Although the articles in this issue were solicited well before 13 Reasons Why was released, they do address these questions and more. The contributions are designed to give clinicians essential information about identifying and addressing youth suicide risk in K-12 and university settings.
The first two articles address suicide risk in schools. In the article, “Identifying and Responding to Suicide Risk in Schools,” I discuss suicide prevention programs and how to respond to specific suicidal situations in K-12 schools. In the article “Suicide Among College Students: Risk and Approaches to Prevention and Management,” Dr. Victor Schwartz discusses suicide risk among college students and presents the JED Foundation model for comprehensive suicide prevention and management. In the third article, “Attachment-Based Family Therapy with Suicidal Adolescents: An Overview,” Quintin Hunt and Drs. Jesse Sandoval-Barrett and Guy Diamond review the empirical support and treatment tasks for attachment-based family therapy (ABFT). ABFT is the only family therapy designed to reduce suicidal ideation in youth.
The last two articles move away from setting and intervention and into issues of diagnosis and assessment. In the fourth article, “An Overview and Comparison of Two Proposed Suicide-Specific Diagnoses: Acute Suicidal Affective Disturbance and Suicide Crisis Syndrome,” Megan L. Rogers, Dr. Igor Galynker, Dr. Zimri Yaseen, Kayla DeFazio, and Dr. Thomas E. Joiner provide an overview of the phenomenology and existing empirical evidence for acute suicidal affective disturbance and suicide crisis syndrome, as well as a comparison between the two conditions. The authors make a compelling argument for the value of suicide-specific diagnoses. In the last article, “Uncovering a Patient's Hidden Method of Choice for Suicide: Insights from the Chronological Assessment of Suicide Events,” Dr. Shawn Christopher Shea provides a roadmap for addressing one of the most complicated and least understood aspects of suicide assessment—uncovering the patient's choice of method for suicide.
I am grateful to the authors, who are leading experts on these topics, for agreeing to contribute to this issue. I hope these articles provide clinically useful tools as well as a broader understanding of the state of youth suicide prevention and intervention.
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS). www.cdc.gov/injury/wisqars. Updated June 1, 2017. Accessed July 13, 2017.
- Centers for Disease Control and Prevention.Youth Risk Behavior Survey (YRBS). Trends in the prevalence of suicide-related behaviors: national YRBS: 1991–2015. https://www.cdc.gov/healthyyouth/data/yrbs/pdf/trends/2015_us_suicide_trend_yrbs.pdf. Accessed July 3, 2017.
- Sisask M, Värnik A. Media roles in suicide prevention: a systematic review. Int J Environ Res Public Health. 2012;9(1):123–138. doi:. doi:10.3390/ijerph9010123 [CrossRef]