Evaluation and Management of a 12-Year-Old After Suicide Attempt

Immediate Risk Assessment

The American Academy of Pediatrics recommends that any 12-year-old who has attempted suicide requires immediate mental health professional evaluation during the current visit, with strong consideration for psychiatric hospitalization to ensure safety and allow comprehensive medical and psychiatric assessment in a controlled environment 1, 2, 3
Intent is the key determinant of risk, and assessment must include lethality of the method used, current suicidal intent, mental status abnormalities, psychiatric comorbidities, and previous attempts 1, 2, 3, 4

Psychiatric hospitalization is indicated when there is a persistent wish to die, high lethality method used, inability to form therapeutic alliance, psychotic symptoms, current intoxication, multiple previous serious attempts, low impulse control, unsupportive family, or inadequate home supervision 1, 2, 3, 5
Outpatient management may be considered only if there is a responsive and supportive family, no current intent or plan, someone available to monitor and act if deterioration occurs, and immediate same-day mental health appointment can be arranged 1, 2, 3

The American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry recommend that parents must explicitly be instructed to remove all firearms from the home, lock up all medications, restrict access to alcohol and substances, and secure knives and other potential means 1, 2, 5, 6, 8

No-suicide contracts have not been proven effective in preventing suicidal behavior, instead, develop a collaborative safety plan that includes identification of warning signs and triggers, specific coping strategies, healthy distraction activities, identified social supports, professional contact information, and means restriction plan 4, 2, 8

Close follow-up is mandatory even for "low-risk" patients, with the greatest risk for reattempting suicide occurring in the months immediately following an initial attempt, and collaborative care between pediatrician and mental health professionals results in greater reduction of depressive symptoms 1, 2, 3, 8

Vigorous treatment of underlying psychiatric disorders is essential for reducing both short-term and long-term suicide risk, and evidence-based psychotherapies include cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), interpersonal therapy (IPT-A), and family therapy 4, 2, 6, 7