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Management of Suicidal Thoughts in Youth

Key Questions Jul 17, 2023
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Suicide is the second leading cause of death among high school-aged youths. In 2019, 18.8% of high school students reported having seriously considered suicide, and groups at even higher risk included females and lesbian, gay, or bisexual youths.1 Other risk factors may include having a mental or substance use disorder, history of childhood trauma, bullying, and having dysregulated sleep. Protective factors include exhibiting resilience, problem-solving skills, having access to health care, positive peer relationships, cultural or religious beliefs that discourage suicide, interpersonal and community connectedness, a safe environment, and positive adult relationships.2

Suicidal ideation refers to thinking or planning suicide.2 Over one third of adolescents who experience suicidal ideation attempt suicide at some point.3 Data from a large longitudinal study in the US from 2000 to 2010 indicated that about 38% of youth up to age 19 sought health services four weeks prior to dying by suicide, and about 17% sought mental health services.4 Treatment is usually conducted by a licensed mental health professional and occurs over multiple sessions.2 The systematic review will be used to develop clinical practice guidelines for management of suicidal thoughts and behaviors in children and young adults.

Key Question 1: What is the effectiveness, comparative effectiveness, and harms of treatments for suicidal thoughts and behaviors?

     KQ1a: What are the components of effective psychological treatments (e.g., frequency or intensity of therapy and/or aspects of the therapeutic modality)?

     KQ1b: How do social determinants of health, racism and disparities affect outcomes?

Draft Analytic Framework (AF)

Figure 1. Draft analytic framework for the treatment of suicidality in youth.

Figure 1: This figure depicts the key question and the 2 sub-questions within the context of the PICOTS described below. In general, the figure illustrates how a treatment or treatments may, when compared to other treatments or usual care, result in improvements in intermediate outcomes such as the continuing with treatment or in patient outcomes such as improvements in the severity or frequency of suicidal thoughts or behaviors or improvements in other aspects of health and quality of life.  Adverse events may occur at any point and include side effects from medications that are part of therapy as well as stigma and decreased participation in aspects of life such as school and social life.    Also depicted are potential effect modifiers of two types:  treatment-related factors such as treatment components and intensity and social determinants of health including age, gender, race/racism, social determinants of health.

Abbreviations: KQ=key question; SDOH=social determinants of health

Questions Key Question 1: What is the effectiveness, comparative effectiveness, and harms of treatments for suicidal thoughts and behaviors?
KQ1a: What are the aspects or components of effective psychological treatments (e.g., frequency or intensity of therapy and/or aspects of the therapeutic modality)?
KQ1b: How do social determinants of health, gender, age, race/racism affect outcomes?
Population Youth ages 10-24 y. who have engaged in suicidal ideation (thinking about or planning suicide) with or without self-injurious behaviors (i.e., suicide, self-injurious behavior including self-directed deliberate injury or potential for injury), or have made suicide attempts in the absence of known suicidal ideation
KQ 1b: Consider socioeconomic status, race, gender, age
Interventions Psychological, pharmacological, complementary, integrative health (e.g., light therapy, supplements), combination therapies
KQ 1a: for psychological treatments, component of treatment, frequency of therapy, intensity of therapy, other intervention factors
Comparators Other psychological, pharmacological, complementary, integrative health, combination therapies; treatment as usual
Outcomes Final health outcomes: Measures of psychological functioning (e.g., suicidality/ideation, depression, anxiety) both as reported by child and caregiver, suicidal behaviors (e.g., suicidal attempts, self-harm), quality of life, school outcomes (e.g., functioning in school).
Any harms: medication side effects, stigma
Timing All/any (short term, long term)
Setting All/any (e.g., outpatient, inpatient, emergency department)

Definition of Terms

Term Definition
AF Analytic framework
APA American Psychological Association
KQ Key question
PICOTS Population, intervention, comparator, outcome, timing, setting


  1. Suicidal Ideation and Behaviors Among High School Students. Centers for Disease Control and Prevention. doi: https://www.cdc.gov/mmwr/volumes/69/su/su6901a6.htm.
  2. Treatment for Suicidal Ideation, Self-Harm, and Suicide Attempts Among Youth. SAMSHA. doi: https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP20-06-01-002.pdf
  3. Daniel SS, Goldston DB. Interventions for suicidal youth: a review of the literature and developmental considerations. Suicide Life Threat Behav. 2009 Jun;39(3):252-68. doi: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2819305/pdf/nihms172692.pdf. PMID: 19606918.
  4. Ahmedani BK, Simon GE, Stewart C, et al. Health care contacts in the year before suicide death. J Gen Intern Med. 2014 Jun;29(6):870-7. doi: https://doi.org/10.1007/s11606-014-2767-3. PMID: 24567199.

Project Timeline

Management of Suicidal Thoughts in Youth

Jul 17, 2023
Topic Initiated
Jul 17, 2023
Key Questions
Page last reviewed July 2023
Page originally created July 2023

Internet Citation: Key Questions: Management of Suicidal Thoughts in Youth. Content last reviewed July 2023. Effective Health Care Program, Agency for Healthcare Research and Quality, Rockville, MD.

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