Management of Suicidal Thoughts and Behaviors in Youth. Systematic Review

Sim L, Wang Z, et al (2025).

Prepared by the Mayo Clinic Evidence-based 

Practice Center under

The information is here.

Abstract

Background: Suicide is a leading cause of death in young people and an escalating public health crisis. We aimed to assess the effectiveness and harms of available treatments for suicidal thoughts and behaviors in youths at heightened risk for suicide. We also aimed to examine how social determinants of health, racism, disparities, care delivery methods, and patient demographics affect outcomes.

Methods: We conducted a systematic review and searched several databases including MEDLINE®, Embase®, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and others from January 2000 to September 2024. We included randomized clinical trials (RCTs), comparative observational studies, and before-after studies of psychosocial interventions, pharmacological interventions, neurotherapeutics, emerging therapies, and combinations therapies. Eligible patients were youths (aged 5 to 24 years) who had a heightened risk for suicide, including youths who have experienced suicidal ideation, prior attempts, hospital discharge for mental health treatment, or command hallucinations; were identified as high risk on validated questionnaires; or were from other at-risk groups. Pairs of independent reviewers selected and appraised studies. Findings were synthesized narratively.

Results: We included 65 studies reporting on 14,534 patients (33 RCTs, 13 comparative observational studies, and 19 before-after studies). Psychosocial interventions identified from the studies comprised psychotherapy interventions (33 studies, Cognitive Behavior Therapy, Dialectical Behavior Therapy, Collaborative Assessment and Management of Suicidality, Dynamic Deconstructive Psychotherapy, Attachment-Based Family Therapy, and Family-Focused Therapy), acute (i.e., 1 to 4 sessions/contacts) psychosocial interventions (19 studies, acute safety planning, family-based crisis management, motivational interviewing crisis interventions, continuity of care following crisis, and brief adjunctive treatments), and school/community-based psychosocial interventions (13 studies, social network interventions, school-based skills interventions, suicide awareness/gatekeeper programs, and community-based, culturally tailored adjunct programs). For most categories of psychotherapies (except DBT), acute interventions, or school/community-based interventions, there was insufficient strength of evidence and uncertainty about suicidal thoughts or attempts. None of the studies evaluated adverse events associated with the interventions. The evidence base on pharmacological treatment for suicidal youths was largely nonexistent at the present time. No eligible study evaluated neurotherapeutics or emerging therapies.

Conclusion: The current evidence on available interventions intended for youths at heightened risk of suicide is uncertain. Medication, neurotherapeutics, and emerging therapies remain unstudied in this population. Given that most treatments were adapted from adult protocols that may not fit the developmental and contextual experience of adolescents or younger children, this limited evidence base calls for the development of novel, developmentally and trauma-informed treatments, as well as multilevel interventions to address the rising suicide risk in youths.

Gun laws lower firearm-related suicides among youth, study shows

Sara Chernikoff

USA Today

Originally posted 20 July 24

New research out of Duke University found that some gun laws can prevent firearm suicides' among children and teens. States with safe storage laws and mandatory waiting periods had lower rates of suicide deaths among children 18 and younger.

These same laws did not decrease the risk of kids being murdered by a firearm, the research found.

Lead researcher Dr. Krista Haines is an assistant professor of surgery and population health sciences at Duke University School of Medicine in North Carolina. Haines told USA TODAY there there was a surge in firearm fatalities across the nation during the COVID-19 pandemic.

"There's not a lot of interventions out there that we found that worked." said Haines "Looking at what legislation is out there that does actually work, we thought would be a good first start."

The article is here.

Here is a summary:

Researchers at Duke University have found that certain gun laws can help prevent firearm suicides among children and teens. A study analyzing data from the Centers for Disease Control and Prevention (CDC) between 2009 and 2020 revealed that states with safe storage laws, mandatory waiting periods, and child access prevention laws had lower rates of suicide deaths among children 18 and younger. However, these laws did not decrease the risk of firearm homicides among this age group. The study's lead researcher, Dr. Krista Haines, emphasizes the need for effective interventions to address the surge in firearm fatalities during the COVID-19 pandemic. The research suggests that implementing laws controlling access to guns among children and teens can help prevent suicides, which are a leading cause of death among this age group in the US.

Young people turning to AI therapist bots

Joe Tidy

BBC.com

Originally posted 4 Jan 24

Here is an excerpt:

Sam has been so surprised by the success of the bot that he is working on a post-graduate research project about the emerging trend of AI therapy and why it appeals to young people. Character.ai is dominated by users aged 16 to 30.

"So many people who've messaged me say they access it when their thoughts get hard, like at 2am when they can't really talk to any friends or a real therapist,"

Sam also guesses that the text format is one with which young people are most comfortable.

"Talking by text is potentially less daunting than picking up the phone or having a face-to-face conversation," he theorises.

Theresa Plewman is a professional psychotherapist and has tried out Psychologist. She says she is not surprised this type of therapy is popular with younger generations, but questions its effectiveness.

"The bot has a lot to say and quickly makes assumptions, like giving me advice about depression when I said I was feeling sad. That's not how a human would respond," she said.

Theresa says the bot fails to gather all the information a human would and is not a competent therapist. But she says its immediate and spontaneous nature might be useful to people who need help.

She says the number of people using the bot is worrying and could point to high levels of mental ill health and a lack of public resources.

The info is here.

Here are some important points-

Reasons for appeal:

• Cost: Traditional therapy's expense and limited availability drive some towards bots, seen as cheaper and readily accessible.
• Stigma: Stigma associated with mental health might make bots a less intimidating first step compared to human therapists.
• Technology familiarity: Young people, comfortable with technology, find text-based interaction with bots familiar and less daunting than face-to-face sessions.

Concerns and considerations:

• Bias: Bots trained on potentially biased data might offer inaccurate or harmful advice, reinforcing existing prejudices.
• Qualifications: Lack of professional mental health credentials and oversight raises concerns about the quality of support provided.
• Limitations: Bots aren't replacements for human therapists. Complex issues or severe cases require professional intervention.

New class of drugs targets aging to help keep you healthy

Jacqueline Howard
CNN.com
Originally published September 5, 2017

Here is an excerpt:

"In the coming decades, I believe that health care will be transformed by this class of medicine and a whole set of diseases that your parents and grandparents have will be things you only see in movies or read in books, things like age-associated arthritis," said David, whose company was not involved in the new paper.

Yet he cautioned that, while many more studies may be on the horizon for senolytic drugs, some might not be successful.

"One thing that people tend to do is, they tend to overestimate things in the short run but then underestimate things in the long run, and I think that, like many fields, this suffers from that as well," David said.

"It will take a while," he said. "I think it's important to recognize that a drug discovery is among the most important of all human activities ... but it takes time, and there must be a recognition of that, and it takes patience."

The article is here.

Tolerable Risks? Physicians and Youth Tackle Football

Kathleen E. Bachynski, M.P.H.
N Engl J Med 2016; 374:405-407

At least 11 U.S. high-school athletes died playing football during the fall 2015 season. Their deaths attracted widespread media attention and provided fodder for ongoing debates over the safety of youth tackle football. In October 2015, the American Academy of Pediatrics (AAP) issued its first policy statement directly addressing tackling in football. The organization’s Council on Sports Medicine and Fitness conducted a review of the literature on tackling and football-related injuries and evaluated the potential effects of limiting or delaying tackling on injury risk. It found that concussions and catastrophic injuries are particularly associated with tackling and that eliminating tackling from football would probably reduce the incidence of concussions, severe injuries, catastrophic injuries, and overall injuries.

But rather than recommend that tackling be eliminated in youth football, the AAP committee primarily proposed enhancing adult supervision of the sport. It recommended that officials enforce the rules of the game, that coaches teach young players proper tackling techniques, that physical therapists and other specialists help players strengthen their neck muscles to prevent concussions, and that games and practices be supervised by certified athletic trainers. There is no systematic evidence that tackling techniques believed to be safer, such as the “heads-up” approach promoted by USA Football (amateur football’s national governing body), reduce the incidence of concussions in young athletes. Consequently, the AAP statement acknowledged the need for further study of these approaches. The policy statement also encouraged the expansion of nontackling leagues as another option for young players.

The article is here.

The Kids Are All Right

Have we made our children into moral monsters?

By Daniel Engber
Slate.com
Originally published March 16, 2015

We’re in the middle of a moral panic—a panic over morals. An op-ed posted Monday in the New York Times warns that our children don’t believe in moral facts. They don’t get that things are right or wrong; they don’t accept the inner truth of values. Should a person lie or cheat or kill to get ahead? Kids today, these kids today, they couldn’t say for sure. I mean, aren’t ethics just, like, a matter of opinion? Everyone totally gets to have their own opinions, amirite?

This Village of the Damned scenario, laid out by Fort Lewis College philosopher Justin McBrayer, has clearly struck a chord. As of Thursday, it sat among the Times’ five most emailed, viewed, and shared articles of the week, and has inspired more than 1,800 comments. McBrayer’s most alarming claim—the one that pushed his essay into Facebook feeds and Twitter timelines—tells us how the nation’s youth came to be so dissolute. If millennials haven’t learned respect for ethics, it’s because we grown-ups let them down.

The entire article is here.

Lady Gaga's foundation supports youth mental health discussions - all by text messaging

By Will Schutt
Medill Reports
Originally posted April 24, 2014

Texting offers new way to get youth engaged in mental health discussions. Creating Community Solutions and Lady Gaga's Born This Way Foundation are sponsoring a texting conversation about mental health. All you need to chime in is a cell phone. The latest digital mental health discussion for and between young people kicks off today.

An emerging mental health “conference” offers a new kind of group rapport: a conversation entirely conducted by texting.

(cut)

Occasionally, people text in who are in crisis. To make sure they get immediate assistance, one of the first texts people receive is the number for the national hotline for mental health crises.

The entire article is here.