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.
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
|APA||American Psychological Association|
|PICOTS||Population, intervention, comparator, outcome, timing, setting|
- 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.
- 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
- 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.
- 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.