Adolescents at Risk of Suicide Today, alarming numbers of young people are contemplating taking their own lives, and many follow through on their suicide ideations to actually kill themselves or to make an attempt. In sum, suicide represents the second-leading cause of death for people aged 15 to 34 years and is the third-leading cause of death among young people aged 10 to 14 years (Suicide facts at a glance, 2015). To gain some additional insights into these issues, this case study provides a description of hypothetical 14-year-old runaway Caucasian adolescent, "Jane," who as referred from a homeless shelter with suicide ideations to determine what screening and testing should be performed, a discussion concerning current recommended treatment protocol, drugs and non-pharmacological interventions, and a description of expected treatment outcomes including a corresponding time frame and follow-up plan. Finally, a summary of the research and important findings concerning adolescents such as Jane who are at risk of suicide are presented in the conclusion.

Review and Discussion

1. Topic description & anticipated examination findings

The subject in this case study is Jane, a representative teenager who ran away from home 2 months ago to get away from an abusive step-father and noncommittal biological mother. Since that time, Jane reports having engaged in sexual acts in return for food and drugs as well as several instances of shoplifting for food but claims she has never been caught. The client appears malnourished, dehydrated, dirty and disheveled with torn clothes and matted hair. The client also admits to contemplating suicide before she ran away and notes that the frequency of these ideations has increased significantly in recent weeks. When asked if she had made any firm plans for carrying out a suicide, Jane concedes that she does not have any concrete ideas but has alternatively considered jumping in front of a fast-moving car or taking an overdose of a drug that "could do the job." The client presents seeking help to "turn her life around" and to address her suicidal thinking patterns.

Unfortunately, Jane's case is certainly not unique or even uncommon. For instance, in 2013 (the latest figures available from the U.S. Centers for Disease Control), nearly one-quarter (22.4%) of female adolescents and just over one in ten (11.6%) male adolescents had seriously considered taking their own lives at some point during the previous year (Suicide facts at a glance, 2015). Moreover, nearly as many male adolescents (10.3%) and even more (16.9%) female adolescents had made plans concerning how they would commit suicide at some point during the previous year.

More troubling still, many adolescents act on these suicide ideations, with about twice as many female adolescents and 5.4% of male adolescents having made at least one suicide attempt during the previous year, and about the same ratio (3.6% of female adolescents and 1.8% of male...

(Suicide facts at a glance, 2015), making the need for timely and accurate assessment essential as discussed below.
2. Patient assessments needed

The assessment of adolescents such as Jane for suicide includes determining their individual needs in order to formulate an efficacious intervention (National Action Alliance for Suicide Prevention, 2013). In sum, patient assessment is needed to identify the reasons that adolescents are contemplating suicide, with a specific focus on the various social and clinical factors that must be taken into account in any type of intervention (National Action Alliance for Suicide Prevention, 2013). There are several assessment tools available, some of which are in the public domain, that are specifically designed for use with adolescents including those set forth in Table 1 below..

Table 1

Suicide risk assessment instruments

Assessment Instrument

Description/Applications

Suicidal Ideation Questionnaire (SIQ)

The SIQ was developed for use with high school-aged youth, and a slightly different version (the SIQ -- JR) is available for ages 12 -- 14 years. The questionnaires are presented as paper-and-pencil tasks or by computer-assisted administration. There are 30 items (questions) in the SIQ and 15 in the SIQ-JR, all focusing on suicidal ideation. Youth are asked how often they experience the thoughts described in the question, selecting from six responses that range from "never" to "almost every day." Norms are available indicating the scores that should raise concern about suicide risk. The SIQ has been studied with a wide range of youth in varied clinical and non-clinical situations, as well as with different cultural backgrounds. Substantial research on the SIQ has demonstrated its good psychometric properties, as well as its ability to identify youth who have histories of suicide attempts or who may make future suicide attempts.

Suicidal Behaviors Questionnaire-Revised (SBQ-R)

The 14-item SBQ-R and the 4-item SBQ-R were originally developed for use with adults, but subsequently have been studied and used with adolescents. On the more-frequently used SBQ-R, youth check any of five responses to whether they have experienced thoughts about killing themselves, whether they have told anyone before about it, and how likely they believe it is that they will attempt suicide someday. The SBQ-R's brevity makes it the quickest screening method available for suicide risk assessment. Validation research has been favorable (identifying youth who were at risk according to other predictors), but use in juvenile justice settings -- and SBQ-R research in those settings -- has been limited. The SBQ-R's greatest value lies in its validation with adolescents in general, its simplicity and ease of administration, and its absence of cost for materials because it is in the public domain.

Global Appraisal of Individual Needs -- Short Screener (GAIN-SS)

The GAIN-SS is a screening companion to a more comprehensive tool called the Global Appraisal of Individual Needs (GAIN). The GAIN is widely used as a structured way to identify the behavioral and mental health service needs of youth. The GAIN requires up to two hours to administer and the GAIN-SS was designed to "screen out" individuals who might not need the more extensive GAIN evaluation. The GAIN-SS has four scales: Internalizing Disorder, Externalizing Disorder, Substance Use Disorder, and Crime/Violence. Each scale has five questions, which are posed to the youth in an interview (not paper-and-pencil). There is no suicide scale, but the Internalizing cluster inquires about depressed mood and includes one item on suicide ideation. Thus, the Internalizing component of the GAIN-SS acts…