Teen checkups should include suicide risk screening

Suicide is among the leading causes of death in U.S. adolescents and while it's not entirely preventable, doctors can minimize the risk by asking the right questions during routine checkups, the American Academy of Pediatrics says.

Pediatricians should ask about mood disorders, use of drugs and alcohol, suicidal thoughts, bullying, sexual orientation and other risk factors for suicide as part of a routine conversation about medical history, the AAP notes in treatment guidelines released today.

About 1,750 teens ages 15 to 19 killed themselves in 2013, Dr. Benjamin Shain writes in the journal Pediatrics.

That number is 28 percent lower than in 1990, but the true suicide rate may be much higher because suicides are often ruled "accidental" when children take their own lives, Shain notes.

The rise of the internet and social media and a shortage of psychiatrists to treat pediatric mental health problems make it essential that doctors and parents be vigilant about the warning signs of suicide, Shain, head of child and adolescent psychiatry at NorthShore University HealthSystem, said by email.

Parents and doctors need to recognize "the increasing complexity of life, particularly as a teen," Shain said.

Teen girls are twice as likely as boys to attempt suicide, Shain wrote in the treatment recommendations. Boys, however, are three times more likely to succeed at killing themselves.

Among adolescents, one in 50 to 100 suicide attempts is successful.

Bullying is associated with an increased risk for suicide for both victims and perpetrators, Shain noted.

While online bullying is a problem unique to teens of this generation, the Internet can also be a source of support that can help teens cope with issues that might contribute to suicidal thoughts, Shain said.

Antidepressant use has become increasingly common among teens and may have contributed to a declining suicide rate. But these medications can also contribute to suicidal thoughts.

When teens take antidepressants, parents and doctors need to watch for signs of increased anxiety, agitation, aggression, impulsivity, insomnia, irritability or self-destructive behavior.

When possible, doctors should also ask about whether firearms are in the home and discuss with parents how guns and ammunition in the house might contribute to an increased risk of suicide.

Doctors should also ask how parents store medications in the home to ensure these are kept in a place where teens can't get to them.

The shortage of psychiatrists and mental health professionals is a difficult problem to tackle, said Dr. Bernard Biermann, an adolescent psychiatry researcher at the University of Michigan's C.S. Mott Children's Hospital.

"Access to mental health services is increasingly challenging due to funding cuts, insurance restrictions and other barriers to care," Biermann, who wasn't involved in the AAP guidelines, said by email.

Teens are also under tremendous pressure to succeed in school, extracurricular activities and social settings, Biermann noted. More and more youth are graduating high school with multiple college credits and feel pressure to perform well in sports and other activities.

"Adolescence is a time of tremendous stress and it seems like today's teens have unusually high, often unreasonable, expectations for themselves," Biermann said. "As a result, depression, anxiety and other mental health concerns are increasingly common as are maladaptive behaviors such as substance abuse, self-injury, eating disorders and other forms of unhealthy coping."

SOURCE: http://bit.ly/297Z0W5 Pediatrics, online June 27, 2016.