Youth suicide prevention

• Published in: Canadian Medical Association journal (CMAJ) Vol. 178; no. 3; pp. 282 - 285
• Main Authors: Kutcher, Stanley P, Szumilas, Magdalena
• Format: Journal Article
• Language: English
• Published: Canada CMA Impact Inc 29.01.2008; CMA Impact, Inc; Canadian Medical Association
• Series: Public health
• Subjects: Adolescent; Adult; Analysis; Canada - epidemiology; Educational aspects; Female; Humans; Male; Mortality; Practice; Prevention; Psychological aspects; Public health; Risk Factors; Suicide; Suicide - prevention & control; Suicide - statistics & numerical data; Suicides & suicide attempts; Teenagers; Youth; Canada
• ISSN: 0820-3946; 1488-2329
• DOI: 10.1503/cmaj.071315

Comparatively, Canadian youth suicide rates, which have decreased in the past decade (Figure 1),2,3 are higher than the rates in the United States,4 Australia5 and the United Kingdom6 (Figure 2) and lower than the rate in New Zealand.7 However, there is substantial variability in regional rates across Canada (Table 1).2 The rate of suicide attempts has remained fairly stable, with youth making up 25% of associated hospital admissions.8 Data comparing rates of completed suicide and suicide attempts suggest that attempts are up to 12 times more common than completed suicides.3 There are sex-related differences in rates, with completed suicides being about 3-5 times more common among males and suicide attempts about twice as common among females.3 Table 2 shows the most common methods of attempted and completed suicide among Canadian youth. Suicide awareness curricula are often used as part of school-based suicide prevention strategies. However, there is little substantial evidence to support their implementation.10 Promising school-based programs include screening students for mental health problems and referring them to mental health professionals and providing teachers with "gatekeeper" training to recognize depression and other mental health disorders in students and to learn the procedures for referral to mental health services. Two other school-based strategies popularly considered to be effective are peer helper programs and post-vention (suicide prevention activities, such as crisis debriefing interventions, aimed at youth recently exposed to a suicide). However, these strategies are not supported by sufficient positive evidence to substantiate widespread or unqualified use.16,17 One promising approach to suicide prevention using the health care system is the training of primary care physicians to recognize, treat and, if necessary, refer patients with mental illness, especially depression.20 Since the treatment of depression has been associated with decreased suicide rates and suicide attempts among youth,21,22 the effective early treatment of depression is an approach that targets a causal as well as a modifiable risk factor. In a national survey about mental health and illness in youth, most of the youth who participated reported that primary care physicians were their first choice for point of contact in case of distress.23 However, in a study assessing the standard of care for pediatric attention-deficit hyperactivity disorder and depression in a region of Ontario, less than 12% of the family physicians surveyed reported comfort in their ability to recognize and treat depression in youth.24 Since training has been found to increase physician identification of suicidal patients25 and to improve treatment of depression and decrease suicide rates,26 it should be more widely available.