A recent systematic review by the Children’s Health Policy Centre found that comprehensive interventions for youth at risk for suicide can effectively reduce suicide attempts and suicidal ideation. These results suggest six implications for policy and practice:

• Include parents in interventions for at-risk children and youth when feasible. All the effective interventions were comprehensive, providing therapeutic components for both young people and their parents, including Multisystemic Therapy, Dialectical Behaviour Therapy, Attachment-Based Family Therapy and the Resourceful Adolescent Parent Program. So when intervening with children and youth at risk for suicide, parents should be included whenever possible.
• Ensure sufficient intervention duration. Results for the brief programs — those delivered in two session or fewer — were generally poor, with all but one (the youth and parent version of Promoting CARE) failing to significantly improve any suicide outcome. Young people with significant risk for suicide therefore likely require interventions that are longer, enabling enough time for them to learn and practise new skills.
• Recognize the possibility of extending benefits by offering booster sessions. The impact of several of the more successful comprehensive interventions waned over time. Still the findings from other studies suggest it may be possible to extend positive benefits by offering booster sessions. For example, a systematic review of 53 studies showed that CBT interventions with booster sessions were more effective and had more enduring effects than those without for young people with mood or anxiety disorders.
• Address underlying mental health concerns that heighten the risk for suicide. Children and youth with mental disorders, especially depression, are at greater risk for suicide than those without these conditions. As well, improving the detection and treatment of mental disorders in general has been identified as crucial to reducing child and youth suicide. Practitioners can help by conducting comprehensive assessments and by providing effective treatments for all children and youth with mental disorders. Policy-makers can help by ensuring adequate public resources to meet these needs.
• Promote protective factors. Given that social connectedness can reduce the likelihood of suicide attempts and ideation, helping youth build positive relationships is a helpful protective strategy. Strengthening connections with both parents and peers can be the focus.
• Be alert for suicide risk in young people receiving mental health services. Many children and youth who die by suicide have had contact with mental health professionals beforehand. A British study found that 26.3% of such young people had received mental health services within the three months before their death. So all mental health practitioners who care for young people need to be alert to the risks and assess for suicide potential. 

The suicide of any young person is a tragedy. It is a devastating loss reflecting great suffering for that child or youth and their family. It is also an exceedingly sad loss for others involved with the young person, including teachers and practitioners. Further research will help define more and better suicide prevention interventions for young people. For more information, see Vol. 17, No. 1 of the Children’s Mental Health Research Quarterly.

A recent systematic review provided insights on how mental health practitioners were affected when someone they had been caring for died by suicide. The most common personal reactions were guilt, blame, shock, anger and sadness. The review also identified what practitioners found beneficial following such a loss. Informal supports were found to be the most helpful, including those from peers, family and friends. Formal supports, including supervision, were noted to be valuable as well. These findings can be used to ensure that when a practitioner loses a young person to suicide, the right personal and professional supports are made available. For more information, see Vol. 17, No. 1  of the Children’s Mental Health Research Quarterly.

Data from Statistics Canada found that Indigenous youth were at higher risk for suicide than their non-Indigenous counterparts; the relative risk was nearly nine times higher for those younger than 15 and slightly more than six times higher for those between 15 and 24. Addressing suicide risk for Indigenous youth is therefore an urgent public health matter. And suicide must be understood within the historical context. The current reality for Indigenous youth stems from the many destructive legacies of colonization. These legacies include the forced removal of generations of children from their families and communities and ongoing exposure to racism and socio-economic disparities.

While the ongoing effects of colonialism must be addressed, one step in lowering suicide rates for Indigenous children and youth is to strengthen cultural connections. These connections include self-governance and settled land claims as well as traditional language teaching and culturally responsive education and health care. So in addition to using effective interventions to prevent suicide, practitioners can support Indigenous youth by encouraging life-affirming cultural connections. For more information, see Vol. 17, No. 1 of the Children’s Mental Health Research Quarterly.

A study that followed a representative sample of almost 5,000 American youth aged 12 to 21 over a one-year period provides information on the role of social connectedness in preventing suicide attempts and ideation. The study authors assessed three types of connection: school relationships, including feeling close to others in this setting; social integration, including feeling accepted, loved and wanted; and connections with parents. All three forms of connection were found to protect young people. Specifically, feeling connected at school was protective against making a suicide attempt, and social integration was protective against suicidal ideation, as was feeling connected to one’s parents. For more information, see Vol. 17, No. 1 of the Children’s Mental Health Research Quarterly.

A better understanding of the role of adverse childhood experiences in suicide deaths comes from an analysis of data relating to nearly 550,000 youth. In this study, researchers followed all individuals born in Sweden between 1987 and 1991 from birth to age 24, assessing eight adverse experiences between birth and age 14. While all eight forms of adversity increased the likelihood of dying by suicide, risk was doubled or more for young people when they had experienced these adversities:

• a family member had died by suicide
• a parent had a criminal history, or
• a parent had a mental disorder.

Other adversities that significantly increased the risk for suicide death by between 40% and 90% included:

• having a parent with problematic substance use
• experiencing a death in the family
• receiving public assistance
• experiencing residential instability, and
• living in a single-parent household.

Notably, suicide risk increased as the number of adversities increased — increasing 90% with two and 160% with three or more. For more information, see Vol. 17, No. 1 of the Children’s Mental Health Research Quarterly.

To understand the relationships between mental disorders and suicide, a recent systematic review examined 24 longitudinal studies involving 12- to 26-year-olds from eight mostly high-income countries, including Canada. Data on more than 25,000 individuals were combined and analyzed. Young people with mental disorders had more than 10 times greater odds of dying by suicide and more than three times greater odds of attempting suicide than those without these disorders. This systematic review also examined how having more than one mental disorder can increase the risk for suicide attempts. Young people with any concurrent mental disorders had nearly nine times greater odds of attempting suicide than those with no disorder. Among the specific diagnoses, young people with mood disorders, including depression, had 54% higher odds for suicide attempts than those with other disorders.

More information on mental health and suicidality comes from a Canadian study that followed a representative sample of more than 6,700 children from ages 10 to 17. The researchers found that when these young people reached adolescence, those with severe conduct disorder symptoms had more than four times greater odds of attempting suicide than those without these problems. Youth who developed severe depressive symptoms had 61% greater odds of experiencing suicidal ideation, and those who used cannabis at least once or twice a month had 74% higher odds. For more information, see Vol. 17, No. 1 of the Children’s Mental Health Research Quarterly.

Findings from a recent review by the Children’s Health Policy Centre offer hope for preventing childhood suicide. These findings suggest five implications for practice and policy:

• Support more research on promising school-based suicide prevention programs. Of the programs we reviewed, Youth Aware of Mental Health (YAM) showed the most promise — reducing suicide attempts as well as reducing serious suicidal ideation by one-year follow-up in a large study spanning 10 countries. However, before considering implementation of this program, replication evaluations are needed, ideally in BC student populations. Policy-makers and practitioners can support researchers in these efforts.

• Recognize that effective programs can be brief, using limited resources. YAM was delivered in one month, with facilitators delivering two lectures and supporting three role-play sessions. Given the demands on schools, the brevity of this program makes it compelling and worth further evaluation.

• Build on the collaborative relationships between practitioners and school personnel. BC has invested in bringing more mental health practitioners into schools. Forging these collaborations can help facilitate suicide prevention programs in BC schools.

• Consider delivery in settings beyond schools. Effective suicide prevention programs could be delivered outside of schools, for example, in after-school programs, which often reach large numbers of children. New evaluations in these settings would also improve the knowledge base, informing new options to help young people.

• Understand the importance of directly teaching suicide prevention skills. Efforts to reduce suicide should ideally involve reaching as many young people as possible using effective universal interventions. Yet the high-quality research evidence on these interventions is still limited. More research is therefore needed. Nevertheless, programs such as YAM can be a helpful starting point. For example, policy-makers and practitioners could collaborate with researchers to conduct new evaluations of this promising program. Doing so can add to the evidence that would benefit young people in BC.

Investing in new research with BC children is an important step toward reducing the impact of suicide in this province.

For more information, see Vol. 16, No. 4 of the Children’s Mental Health Research Quarterly.

The Fort Apache community in Arizona set out to teach youth business development and life skills while promoting a positive Apache identify. They did so by developing an eight-month community-based program for 13- to 16-year-olds. The program did not make a significant difference for suicide attempts or involvement in physical fights. However, at two-year follow-up, youth who participated in the program had significantly lower rates of past month cannabis use. The rate was 24.1% for youth who received the intervention compared to 31.4% for youth in the control group.

For more information, see Vol. 16, No. 4 of the Children’s Mental Health Research Quarterly.