Adolescent Suicidal Behaviour: Psychiatric Populations

Psychiatrists who treat adolescents with psychiatric disorders are confronted daily with the clinical dilemma of suicidal behaviour. There has been a major increase in the prevalence of suicide among the young in the last few decades. It has been shown that psychiatric disorder and history of psychiatric treatment are major risk factors for all types of suicidality, both non-fatal and fatal. Almost any diagnosable psychiatric disorder, especially affective disorder, is a major risk factor for youth suicide. Psychiatric disorders are particularly dangerous when they occur in combination with other risk factors for suicide and when more than one disorder is present. This chapter reviews theoretical and empirical aspects of the relationship between psychiatric disorders and suicidal behaviour. Several psychiatric disorders, including affective disorders, schizophrenia, substance abuse, conduct disorders, eating disorders, borderline personality disorder and their relationship to suicidality, are described. Many psychiatric disorders seem to occur together and the boundaries between them are often unclear. Thus there may be four co-morbid constellations which have special significance for suicide among adolescents and which require vigorous psychiatric intervention. The first is the combination of schizophrenia, depression and substance abuse. The second is substance abuse, conduct disorder and depression. The third comprises affective disorder, eating disorder and anxiety disorders, and the fourth consists of affective disorder, personality disorder and dissociative disorders.