Given these findings, it is apparent that brief screens used at routine checkups are not detecting many adolescents at risk for suicide, wrote Jason D. Jones, Ph.D., of the Department of Child and Adolescent Psychiatry at Children’s Hospital of Philadelphia. “This highlights the urgent need for continued training of pediatric primary care physicians in the evaluation and management of suicidal ideation and the importance of collecting information from multiple informants and rectifying discrepant reports.”
Jones and colleagues analyzed data on more than 5,000 adolescents and their parents or stepparents from the Philadelphia Neurodevelopmental Cohort. The latter is a research initiative combining genetic, neurodevelopmental, neuroimaging, and behavioral data on more than 9,000 adolescents aged 11 to 21 recruited from a large pediatric health network.
During a computerized, structured clinical interview, adolescents were asked these questions: “Have you ever thought about killing yourself?” and “Have you ever thought a lot about death or dying?” Parents answered the same questions about their adolescents’ suicidal thoughts and thoughts of death.
Half of all parents were unaware of their adolescents’ suicidal thoughts, and three-quarters of the parents were unaware that their children harbored recurrent thoughts of death. Moreover, when parents did report that their adolescent children had thoughts of suicide or death, the children frequently denied it: 48.4% of adolescents denied thinking about killing themselves, and 67.5% denied thoughts of death reported by parents. Age and previous psychiatric treatment were associated with better parent-child agreement.
In an accompanying editorial, Khyati Brahmbhatt, M.D., and Jacqueline Grupp-Phelan, M.P.H., M.D., of San Francisco Benioff Children’s Hospital, agreed with the recommendations that multi-informant assessments should be used and disagreements should be carefully explored.
“Including parents and other sources of information in assessments may help capture a larger percentage of adolescents who are at risk,” they wrote. “Further research to improve our understanding of factors driving the denial of symptoms by adolescents and its relation to the risk for suicide attempts is needed. It may help inform screening as well as interventions and ultimately enhance our ability to effectively address suicide in adolescents.”
For related information see the Psychiatric News article "Irritability in Childhood May Point to Teens at High Risk for Suicide."