Evidence-Based Prevention and Treatment of Suicidal Behavior in Children and Adolescents

This chapter reviews the literature on evidenced-based prevention and treatment of suicidal behaviour in children and adolescents. Initially we explore the epidemiology and risk factors since this knowledge is fundamental to successful prevention and treatment. The recent drop in adolescent suicide rates in high income countries is reviewed in the light of the increased use of selective serotonin reuptake inhibitor (SSRI) medications for adolescent depression. In low income countries the reduction in suicide rates also stems from attempts to control pesticides. The extent to which biological and genetic risk factors interact with environmental factors is considered, as well as the more recent evidence on social and psychological factors. There is still a paucity of assessment tools for evaluating suicide risk and effectiveness of prevention or treatment among children and adolescents, however the Columbia-Suicide Severity Rating Scale (C-SSRS) seems promising. Universal and selective prevention programmes are reviewed with a specific focus on school-based programmes, including screening, gatekeeper training and suicide awareness educational curricula for students. These clearly need further systematic and longer-term evaluation. There are only two evidence-based therapies which have shown some efficacy in the treatment of suicidal adolescents (indicated prevention) and those are CBT and DBT.