April 16, 1999

Screening youth for suicide risk factors can facilitate treatment of underlying mental illness and reduce the high suicide rate, according to an article published in last month's supplement to the Journal of Clinical Psychiatry.

Suicide remains a top killer of young Americans. It is the third-leading cause of death among adolescents aged 15 to 19 and the second leading cause of death of adults aged 19 to 24, according to the American Foundation for Suicide Prevention.

"Research demonstrates that suicide should be regarded as a fatal complication of several underlying diseases, each of which is treatable," said primary author David Shaffer, M.D., in a press statement. He is director of the division of child and adolescent psychiatry at Columbia University's College of Physicians and Surgeons.

"About 90 percent of teenagers who die by suicide have a mental illness. The teens at highest risk are boys aged 17 to 19 who are depressed and drink heavily to the point of intoxication," said Shaffer. He noted that most girls who are suicidal suffer from uncomplicated major depression.

In addition, stressful events generally precede an adolescent's suicide attempt, such as a disciplinary crisis, trouble with the law or at school, or the loss of a relationship, notes the article.

The authors found that a three-stage screening method for high school students was effective at identifying those students at risk for suicide. A brief questionnaire (Columbia Teen Screen) asks students about previous suicide attempts, suicidal thoughts, and substance abuse, according to the article. Students who responded positively were given the computerized Diagnostic Interview Schedule for Children (DISC).

Shaffer notes that this screening approach is cost-efficient because the self-reported questionnaire screens out students not at risk for suicide before they see a clinician. In addition, the DISC can be administered by lay people at low cost and generates a report that is presented to a clinician.

In the third stage, a clinician interviews students who have admitted to a suicide attempt or recent suicidal ideation, and have a major depressive or dysthymic disorder or a substance abuse problem, according to the article. The purpose of the interview is to determine whether the student needs to be referred for treatment or further evaluation, according to the article.

Finally, a case manager contacts the parents of students who need additional intervention to assist them and to ensure treatment compliance.