Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter September 4, 2013

Educating health care trainees and professionals about suicide prevention in depressed adolescents

  • Timothy R. Rice EMAIL logo and Leo Sher


Adolescent depression is a highly prevalent disorder with significant morbidity and suicide mortality. It is simultaneously highly responsive to treatment. Adolescents wish to discuss depression with their providers, and providers routinely receive opportunities to do so. These characteristics of prevalence, morbidity, mortality, responsiveness, and accessibility make adolescent depression an excellent target of care. However, most health care trainees and professionals report low confidence in caring for adolescent depression. As a caregiver community, we fare poorly in routine matters of assessment and management of adolescent depression. All health care professionals are trained within a medical model. In this light, the conceptualization of adolescent depression and suicidality within the medical model may increase provider confidence and performance. Epidemiology and neurobiology are presented with emphasis in this review. Legal concerns also affect health care professionals. For example, providers may deviate from evidence-based medicine owing to anxieties that the identification and treatment of depression may induce suicide and consequent legal culpability. A review of the historical context and relevant outcome trials concerning the increased risk of suicidality in depressed adolescents treated with selective-serotonin reuptake inhibitors may increase provider comfort. Furthermore, increased didactic and experiential training improve provider performance. In this work, proven models were discussed, and the testable hypothesis that education incorporating the views of this article can produce the best care for depressed adolescents.

Corresponding author: Timothy R. Rice, MD, Department of Psychiatry, Mount Sinai School of Medicine, Box 1230, One Gustave L. Levy Place, New York, NY 10029, USA


1. Merikangas KR, He J, Burstein M, Swanson SA, Avenevoli S, et al. Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Survey Replication Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry 2010;49:980–9.10.1016/j.jaac.2010.05.017Search in Google Scholar PubMed PubMed Central

2. Fleming JE, Boyle MH, Offod DR.The outcome of adolescent depression in the Ontario child health study follow-up. J Am Acad Child Adolesc Psychiatry 1993;32:28–33.10.1097/00004583-199301000-00005Search in Google Scholar PubMed

3. Weissman MM, Wolk S, Goldstein RB, Moreau D, Adams P, et al. Depressed adolescents grown up. J Am Med Assoc 1999;281:1707–13.10.1001/jama.281.18.1707Search in Google Scholar PubMed

4. Joffe A, Radius S, Gall M. Health counseling for adolescents: what they want, what they get, and who gives it. Pediatrics 1998;82:481–5.10.1542/peds.82.3.481Search in Google Scholar

5. Richardson LP, Russo JE, Lozano P, McCauley E, Katon W. Factors associated with detection and receipt of treatment for youth with depression and anxiety disorders. Acad Pediatr 2010;10:36–40.10.1016/j.acap.2009.09.011Search in Google Scholar PubMed PubMed Central

6. Klein J, Allan M, Elster A, Stevens D, Cox C, et al. Improving adolescent preventive care in community centers. Pediatrics 2001;107:318–27.10.1542/peds.107.2.318Search in Google Scholar PubMed

7. Fallucco E, Hanson M, Glowinski A. Teaching pediatric residents to assess adolescent suicide risk with a standardized patient module. Pediatrics 2010;125:953–9.10.1542/peds.2009-2135Search in Google Scholar PubMed

8. Frankenfield D, Keyl P, Gielen A, Wissow L, Werthamer L, et al. Adolescent patients: healthy or hurting? Missed opportunities to screen for suicide risk in the primary care setting. Arch Pediatr Adolesc Med 2000;154:162–8.10.1001/archpedi.154.2.162Search in Google Scholar PubMed

9. Sudak D, Roy A, Sudak H, Lipschitz A, Maltsberger J, et al. Deficiencies in suicide training in primary care specialties: A survey of training directors. Acad Psychiatry 2007; 22:21–8.10.1176/appi.ap.31.5.345Search in Google Scholar PubMed

10. Simon RI, Shuman DW. Therapeutic risk management of clinical-legal dilemmas: Should it be a core competency? J Am Acad Psychiatr Law 2009;37:155–61.Search in Google Scholar

11. Weir JM, Zakama A, Rao U. Developmental risk I: Depression and the developing brain. Child Adoles Psychiatric Clin North Am 2012;21:237–59.10.1016/j.chc.2012.01.004Search in Google Scholar PubMed PubMed Central

12. Durston S, Hulshoff Pol HE, Casey BJ, Giedd JN, Buitelaar JK, et al. Anatomical MRI of the developing human brain: What have we learned? J Am Acad Child Adolesc Psychiatry 2001;40:1012–20.10.1097/00004583-200109000-00009Search in Google Scholar

13. Giorgio A, Watkins KE, Chadwick M, James S, Winmill L, et al. Longitudinal changes in grey and white matter during adolescence. Neuro Image 2010;49:94–103.10.1016/j.neuroimage.2009.08.003Search in Google Scholar

14. McClure HH, Eddy JM, Kjellstrand JM, Snodgrass JJ, Martinez CR Jr. Child and adolescent affective and behavioral distress and elevated adult body mass index. Child Psychiatry Hum Dev 2012 Mar 27. [Online ahead of print].10.1007/s10578-012-0299-9Search in Google Scholar

15. Mendel JR, Berg CJ, Windle RC, Windle M. Predicting young adulthood smoking among adolescent smokers and nonsmokers. Am J Health Behav 2012;36:542–54.10.5993/AJHB.36.4.11Search in Google Scholar

16. Kessler RC, Avenevoli S, Ries Merikangas K. Mood disorders in children and adolescents: an epidemiologic perspective. Biol Psychiatry 2001;49:1002–14.10.1016/S0006-3223(01)01129-5Search in Google Scholar

17. Essau CA, Chang WC. Epidemiology, comorbidity, and course of adolescent depression. In: Essau CA, editor. Treatments for adolescent depression: theory and practice. Oxford: Oxford University Press, 2009.Search in Google Scholar

18. Joinson C, Heron J, Araya R, Paus T, Croudace T, et al. Association between pubertal development and depressive symptoms in girls from a UK cohort. Psychol Med 2012 Apr 12. [Online ahead of print]10.1017/S003329171200061XSearch in Google Scholar PubMed

19. Angold A, Costello EJ. Depressive comorbidity in children and adolescents: empirical, theoretical, and methodological issues. Am J Psychiatry 1993;150:1779–91.10.1176/ajp.150.12.1779Search in Google Scholar PubMed

20. Costello EJ, Foley DL, Angold A. 10-year research update review: the epidemiology of child and adolescent psychiatric disorders: II. Developmental epidemiology. J Am Acad Child Adolesc Psychiatry 2006;45:8–25.10.1097/01.chi.0000184929.41423.c0Search in Google Scholar PubMed

21. Pine DS, Goldstein RB, Wolk S, Weissman MM. The association between childhood depression and adulthood body mass index. Pediatrics 2001;107:1049–56.10.1542/peds.107.5.1049Search in Google Scholar PubMed

22. Lewinsohn PM, Rohde P, Seeley JR. Adolescent psychopathology: III. The clinical consequences of comorbidity. J Am Acad Child Adolesc Psychiatry 1995;34:510–9.10.1097/00004583-199504000-00018Search in Google Scholar PubMed

23. Brody AL, Saxena S, Silverman DH, Alborzian S, Fairbanks LA, et al. Brain metabolic changes in major depressive disorder from pre- to post-treatment with paroxetine. Psychiatr Res 1999;91:127–39.10.1016/S0925-4927(99)00034-7Search in Google Scholar

24. Forbes EE, Hariri AR, Martin SL, Silk JS, Moyles DL, et al. Altered striatal activation predicting real-world positive affect in adolescent major depressive disorder. Am J Psychiatry 2009;166:64–73.10.1176/appi.ajp.2008.07081336Search in Google Scholar PubMed PubMed Central

25. Forbes EE, May JC, Siegle GJ, Ladouceur CD, Ryan ND, et al. Reward-related decision-making in pediatric major depressive disorder: an fMRI study. J Child Psychol Psychiatry 2006;47:1031–40.10.1111/j.1469-7610.2006.01673.xSearch in Google Scholar PubMed PubMed Central

26. Cohen-Cory S, Kidane AH, Shirkey NJ, Marshak S. Brain-derived neurotrophic factor and the development of structural neuronal connectivity. Dev Neurobiol 2010;70:271–88.10.1002/dneu.20774Search in Google Scholar PubMed PubMed Central

27. Castren E, Rantamki T. The role of BDNF and its receptors in depression and antidepressant drug action: reactivation of developmental plasticity. Dev Neurobiol 2010;70:289–97.10.1002/dneu.20758Search in Google Scholar PubMed

28. Sher L. Brain-derived neurotrophic factor and suicidal behavior in adolescents. World J Pediatr 2011;7:197–8.10.1007/s12519-011-0316-2Search in Google Scholar PubMed

29. Hilt LM, Sander LC, Nolen-Hoeksema S, Simen AA. The BDNF Val66Met polymorphism predicts rumination and depression differently in young adolescent girls and their mothers. Neurosci Lett 2007;429:12–6.10.1016/j.neulet.2007.09.053Search in Google Scholar PubMed

30. Chen J, Li X, McGue M. Interacting effect of BDNF Val66Met polymorphism and stressful life events on adolescent depression. 2012 Aug 29. [Online ahead of print]10.1111/j.1601-183X.2012.00843.xSearch in Google Scholar PubMed

31. Vigil P, Orellana RF, Cortes ME, Molina CT, Switzer BE, et al. Endocrine modulation of the adolescent brain: A review. J Pediatr Adolesc Gynecol 2011;24:330–7.10.1016/j.jpag.2011.01.061Search in Google Scholar PubMed

32. Shansky RM, Glavis-Bloom C, Lerman D, McRae P, Benson C, et al. Estrogen mediates sex differences in stress-induced prefrontal cortex dysfunction. Mol Psychiatry 2004;9:531–8.10.1038/ in Google Scholar PubMed

33. Karg K, Burmeister M, Shedden K, Sen S. The serotonin transporter promoter variant (5-HTTLPR), stress, and depres- sion meta-analysis revisited: evidence of genetic moderation. Arch Gen Psychiatry 2011;68:444–54.10.1001/archgenpsychiatry.2010.189Search in Google Scholar

34. Caspi A, Sugden K, Moffitt TE, Taylor A, Craig IW, et al. Influence of life stress on depression: moderation by a polymorphism in the 5-HTT gene. Science 2003;301:386–9.10.1126/science.1083968Search in Google Scholar

35. Priess-Groben HA, Hyde JS. 5-HTTLPR X stress in adolescent depression: Moderation by MAOA and gender. J Abnorm Child Psychol 2012 Jul 27. [Online ahead of print]10.1007/s10802-012-9672-1Search in Google Scholar

36. Lopez-Duran NL, Kovacs M, George CJ. Hypothalamic-pituitary-adrenal axis dysregulation in depressed children and adolescents: a meta-analysis. Psychoneuroendocrinology 2009;34:1272–83.10.1016/j.psyneuen.2009.03.016Search in Google Scholar

37. Leonard BE. The HPA and immune axes in stress: the involvement of the serotonergic system. Eur Psychiatry 2005;20:S302–6.10.1016/S0924-9338(05)80180-4Search in Google Scholar

38. Mueller A, Brocke B, Fries E, Lesch KP, Kirschbaum C. The role of the serotonin transporter polymorphism for the endocrine stress response in newborns. Psychoneuroendocrinology 2010;35:289–96.10.1016/j.psyneuen.2009.07.002Search in Google Scholar PubMed

39. Birmaher B, Brent D, Bernet W, Bukstein O, Walkter H, et al. Practice parameter for the assessment and treatment of children and adolescents with depressive disorders. J Am Acad Child Adoles Psychiatry 2007;46:1503–26.10.1097/chi.0b013e318145ae1cSearch in Google Scholar PubMed

40. Weisz JR, McCarty CA, Valeri SM. Effects of psychotherapy for depression in children and adolescents: a meta-analysis. Psychol Bull 2006;132:132–49.10.1037/0033-2909.132.1.132Search in Google Scholar PubMed PubMed Central

41. Kratochvil CJ, Vitiello B, Walkup J, Emslie G, Waslick BD, et al. Selective serotonin reuptake inhibitors in pediatric depression: is the balance between benefits and risks favorable? J Child Adol Psychol 2006;16:11–24.10.1089/cap.2006.16.11Search in Google Scholar PubMed

42. Yu Z, Kratochvil CJ, Weller RA, Mooreville M, Weller EB. From TADS and SOFTADS to TORDIA and beyond: What?s new in the treatment of adolescent depression. Curr Psychiatry Rep 2010;12:88–95.10.1007/s11920-010-0094-xSearch in Google Scholar PubMed

43. Emslie GJ, Heiligenstein JH, Wagner KD, Hoog SL, Ernest DE, et al. Fluoxetine for acute treatment of depression in children and adolescents: A placebo-controlled, randomized clinical trial. J Am Acad Child Adolesc Psychiatry 2002;41:1205–15.10.1097/00004583-200210000-00010Search in Google Scholar PubMed

44. Birmaher B, Brent DA, Benson RS. Summary of the practice parameters for the assessment and treatment of children and adolescents with depressive disorders. J Am Acad Child Adolesc Psychiatry 1998;37:1234–8.10.1097/00004583-199811000-00029Search in Google Scholar PubMed

45. Valuck RJ, Libby AM, Sills MR, Giese AA, Allen RR. Antidepressant treatment and risk of suicide attempt by adolescents with major depressive disorder: A propensity-adjusted retrospective cohort study. CNS Drugs 2004;18:1119–32.10.2165/00023210-200418150-00006Search in Google Scholar PubMed

46. Emslie GJ, Ventura D, Korotzer A, Tourkodimitris S. Escitalopram in the treatment of adolescent depression: a randomized placebo-controlled multisite trial. J Am Acad Child Adolesc Psychiatry 2009;48:721–9.10.1097/CHI.0b013e3181a2b304Search in Google Scholar PubMed

47. March J, Silva S, Petrycki S, Curry J, Wells K, et al. Treatment for Adolescents With Depression (TADS) Team: fluoxetine, cognitive-behavioral therapy, and their combination for adolescents with depression: Treatment for Adolescents with Depression Study (TADS) randomized controlled trial. J Am Med Assoc 2004;292:807–20.10.1001/jama.292.7.807Search in Google Scholar PubMed

48. Brent D, Emslie G, Clarke G, Wagner KD, Asarnow JR, et al. Switching to another SSRI or to venlafaxine with or without cognitive behavioral therapy for adolescents with SSRI-resistant depression: the TORDIA randomized controlled trial. J Am Med Assoc 2008;299:901–13.10.1001/jama.299.8.901Search in Google Scholar PubMed PubMed Central

49. The Treatment for Adolescents with Depression (TADS) Team. The Treatment for Adolescents with Depression Study (TADS): outcomes over 1 year of naturalistic follow-up. Am J Psychiatry 2009;166:1141–9.10.1176/appi.ajp.2009.08111620Search in Google Scholar PubMed

50. Domino ME, Foster EM, Vitiello B, Kratochvil CJ, Burns BJ, et al. Relative cost-effectiveness of treatments for adolescent depression: 36-week results from the TADS randomized trial. J Am Acad Child Adolesc Psychiatry 2009;48:711–20.10.1097/CHI.0b013e3181a2b319Search in Google Scholar PubMed

51. Reinherz H, Tanner J, Berger S, Beardslee W, Fitzmaurice G. Adolescent suicidal ideation as predictive of psychopathology, suicidal behavior, and compromised functioning at age 30. Am J Psychiatry 2006;163:1226–32.10.1176/ajp.2006.163.7.1226Search in Google Scholar

52. Lindqvist P, Johansson L, Karlsson U. In the aftermath of teenage suicide: a qualitative study of the psychosocial consequences for the surviving family members. BMC Psychiatry 2008;8:26.10.1186/1471-244X-8-26Search in Google Scholar PubMed PubMed Central

53. Cox GR, Robinson J, Williamson M, Lockley A, Cheung YTD, et al. Suicide clusters in young people: Evidence for the effectiveness of postvention strategies. Crisis 2012;33:2082–14.10.1027/0227-5910/a000144Search in Google Scholar

54. Centers for Disease Control and Prevention. WISQARS leading causes of death reports, 1999–2009. Atlanta, GA: CDC, 2012.Search in Google Scholar

55. Patton GC, Coffey C, Sawyer SM, Viner RM, Haller DM, et al. Global patterns of mortality in young people: a systematic analysis of population health data. Lancet 2009;374:881–92.10.1016/S0140-6736(09)60741-8Search in Google Scholar

56. Macintosh J. USA suicide: 2007 official data: report for the American Association of Suicidology. 2007. Available online at:, access date April 25th, 2012.Search in Google Scholar

57. Centers for Disease Control and Prevention. Youth risk behavior surveillance – United States, 2009. Morb Mort Week Rep 2010;59(SS-5):1–142.Search in Google Scholar

58. Hawton K, Saunders KEA, O’Connor RC. Self-harm and suicide in adolescents. Lancet 2012;379:2373–82.10.1016/S0140-6736(12)60322-5Search in Google Scholar

59. McKeown RE, Cuffe SP, Schulz RM. US suicide rates by age group, 1970–2002: an examination of recent trends. Am J Public Health 2006;96:1744–51.10.2105/AJPH.2005.066951Search in Google Scholar PubMed PubMed Central

60. Morrell S, Page AN, Taylor RJ. The decline in Australian young male suicide. SocSci Med 2007;64:747–54.10.1016/j.socscimed.2006.09.027Search in Google Scholar PubMed

61. Kutcher SP, Szumilas M. Youth suicide prevention. Can Med Assoc J 2008;178:282–5.Search in Google Scholar

62. Varnik A, Kolves K, Allik J, Arensman E, Aromaa E, et al. Gender issues in suicide rates, trends and methods among youths aged 15–24 in 15 European countries. J Affect Disord 2009;113:216–26.10.1016/j.jad.2008.06.004Search in Google Scholar PubMed

63. Gibbons RD, Brown CH, Hur K, Marcus SM, Bhaumik DK, et al. Early evidence on the effects of regulators’ suicidality warnings on SSRI prescriptions and suicide in children and adolescents. Am J Psychiatry 2007;164:1356–63.10.1176/appi.ajp.2007.07030454Search in Google Scholar PubMed

64. Wasserman D, Cheng Q, Jiang GX. Global suicide rates among young people aged 15–19. World Psychiatry 2005;4:114–20.Search in Google Scholar

65. Hepp U, Stulz N, Unger-Koppel J. Methods of suicide used by children and adolescents. Eur Child Adolesc Psychiatry 2012;21:67–73.10.1007/s00787-011-0232-ySearch in Google Scholar PubMed

66. Skinner R, McFaull S. Suicide among children and adolescents in Canada: trends and sex differences, 1980–2008. Can Med Assoc J 2012;184:1029–34.10.1503/cmaj.111867Search in Google Scholar PubMed PubMed Central

67. Andrews JA, Lewinsohn PM. Suicidal attempts among older adolescents: prevalence and co-occurrence with psychiatric disorders. J Am Acad Child Adolesc Psychiatry 1992;31: 655–62.10.1097/00004583-199207000-00012Search in Google Scholar PubMed

68. Hawton K, van Heeringen K. Suicide. Lancet 2009;373:1372–81.10.1016/S0140-6736(09)60372-XSearch in Google Scholar

69. Ganz D, Sher L. Suicidal behavior in adolescents with comorbid depression and alcohol abuse. Minerva Pediatr 2009;61:333–47.Search in Google Scholar

70. Sher L. The concept of post-traumatic mood disorder. Med Hypotheses 2005;65:205–10.10.1016/j.mehy.2005.03.014Search in Google Scholar PubMed

71. Sher L. The concept of post-traumatic mood disorder and its implications for adolescent suicidal behavior. Minerva Pediatr 2008;60:1393–9.Search in Google Scholar

72. Teicher MH, Glod C, Cole JO. Emergence of intense suicidal preoccupation during fluoxetine treatment. Am J Psychiatry 1990;147:207–10.10.1176/ajp.147.2.207Search in Google Scholar PubMed

73. King RA, Riddle MA, Chappell PB, Hardin MT, Anderson GM, et al. Emergence of self-destructive phenomena in children and adolescents during fluoxetine treatment. J Am Acad Child Adolesc Psychiatry 1991;30:179–86.10.1097/00004583-199103000-00003Search in Google Scholar PubMed

74. Beasley CM, Dornseif BE, Bosomworth JC, Sayler ME, Rampey AH Jr, et al. Fluoxetine and suicide: a meta-analysis of controlled trials of treatment for depression. Br Med J 1991;303:685–92.10.1136/bmj.303.6804.685Search in Google Scholar PubMed PubMed Central

75. Khan A, Khan S, Kolts R, Brown WA. Suicide rates in clinical trials of SSRIs, other antidepressants, and placebo: analysis of FDA reports. Am J Psychiatry 2003;160:790–2.10.1176/appi.ajp.160.4.790Search in Google Scholar PubMed

76. Hammad TA. Results of the analysis of suicidality in pediatric trials of newer antidepressants. Psychopharmacology Drugs Advisory Committee and the Pediatric Advisory Committee, September 13–14, 2004. Online document at: in Google Scholar

77. Barry CL, Busch SH. News media coverage of FDA warnings on pediatric antidepressant use and suicidality. Pediatrics 2010;125:88–95.10.1542/peds.2009-0792Search in Google Scholar PubMed PubMed Central

78. Libby AM, Orton HD, Valuck RJ. Persisting decline in depression treatment after FDA warnings. Arch Gen Psychiatry 2009;66:633–9.10.1001/archgenpsychiatry.2009.46Search in Google Scholar PubMed

79. Libby AM, Brent DA, Morrato EH, Orton HD, Allen R, et al. Decline in treatment of pediatric depression after FDA advisory on risk of suicidality with SSRIs. Am J Psychiatry 2007;164:884–91.10.1176/ajp.2007.164.6.884Search in Google Scholar PubMed

80. Olfson M, Shaffer D, Marcus SC, Greenberg T. Relationship between antidepressant medication treatment and suicide in adolescents. Arch Gen Psychiatry 2003;60:978–82.10.1001/archpsyc.60.9.978Search in Google Scholar PubMed

81. Gibbons RD, Hur K, Bhaumik DK, Mann JJ. The relationship between antidepressant prescription rates and rate of early adolescent suicide. Am J Psychiatry 2006;163:1898–904.10.1176/ajp.2006.163.11.1898Search in Google Scholar PubMed

82. Gibbons RD, Kwan H, Brown H, Davis JM, Mann JJ. Benefits from antidepressants: synthesis of 6-Week patient-level outcomes from double-blind placebo-controlled randomized trials of fluoxetine and venlafaxine. Arch Gen Psychiatry 2012 Mar 5. [Online ahead of print]10.1001/archgenpsychiatry.2011.2044Search in Google Scholar PubMed PubMed Central

83. Blazquez A, Mas S, Plana MT, Lafuente A, Lazaro L. Fluoxetine pharmacogenetics in child and adult populations. Eur Child Adolesc Psychiatry 2012 Jul 12. [Online ahead of print]10.1007/s00787-012-0305-6Search in Google Scholar PubMed

84. Macaluso M, Preskorn SH. How biomarkers will change psychiatry: from clinical trials to practice. Part I: introduction. J Psychiatr Pract 2012;18:118–21.10.1097/01.pra.0000413277.11091.25Search in Google Scholar PubMed

85. Schmidt HD, Shelton RC, Duman RS. Functional biomarkers of depression: diagnosis, treatment, and pathophysiology. Neuropsychopharmacology 2011;36:2375–94.10.1038/npp.2011.151Search in Google Scholar PubMed PubMed Central

86. Mann JJ. Candidate endophenotypes for genetic studies of suicidal behavior. Biol Psychiatry 2009;65:556–63.10.1016/j.biopsych.2008.11.021Search in Google Scholar PubMed PubMed Central

87. Wren FJ, Scholle SH, Heo J, Comer DM. Pediatric mood and anxiety syndromes in primary care: Who gets identified? Int J Psychiatry Med 2003;33:1–16.10.2190/UT6D-RDFG-LBT7-G39NSearch in Google Scholar PubMed

88. Basco MR, Bostic JQ, Davies D, Rush AJ, Witte B, et al. Methods to improve diagnostic accuracy in a community mental health setting. Am J Psychiatry 2000;157:1599–605.10.1176/appi.ajp.157.10.1599Search in Google Scholar PubMed

89. Stein RE, Horwitz SM, Storfer-Isser A, Heneghan A, Olson L, et al. Do pediatricians think they are responsible for identification and management of child mental health problems? Results of the AAP periodic survey. Ambul Pediatr 2008;8:11–7.10.1016/j.ambp.2007.10.006Search in Google Scholar PubMed

90. Isometsa E, Heikkinen M, Marttunen M, Henriksson M, Aro H, et al. The last appointment before suicide: Is suicide intent communicated? Am J Psychiatry 1995;152:919–22.10.1176/ajp.152.6.919Search in Google Scholar PubMed

91. Mckelvey R, Pfaff J, Acres J. The relationship between chief complaints, psychological distress, and suicidal ideation in 15–24-year-old patients presenting to general practitioners. Med J Aust 2001;175:550–2.10.5694/j.1326-5377.2001.tb143718.xSearch in Google Scholar PubMed

92. Gould M, Marrocco F, Kleinman M, Thomas JG, Mostkoff K, et al. Evaluating iatrogenic risk of youth suicide screening programs: a randomized controlled trial. J Am Med Assoc 2005;239:1635.10.1001/jama.293.13.1635Search in Google Scholar PubMed

93. Cox A, Holbrok D, Rutter M. Psychiatric interviewing techniques, VI: experimental study: eliciting feelings. Br J Psychiatry 1981;139:144–52.10.1192/bjp.139.2.144Search in Google Scholar PubMed

94. Wissow L, Modena M, Roter D. Pediatrician interview style and mother’s disclosure of psychosocial issues. Pediatrics 1994;93:289.10.1542/peds.93.2.289Search in Google Scholar

95. Tompson MC, Boger KD, Asarnow JR. Enhancing the developmental appropriateness of treatment for depression in youth: Integrating the family in treatment. Child Adolesc Psychiatr Clin North Am 2012;21:345–84.10.1016/j.chc.2012.01.003Search in Google Scholar PubMed PubMed Central

96. Diamond GS, Reis BF, Diamond GM, Siqueland L, Issacs L. Attachment-based family therapy for depressed adolescents: a treatment development study. J Am Acad Child Adolesc Psychiatry 2002;41:1190–6.10.1097/00004583-200210000-00008Search in Google Scholar PubMed

97. Diamond GS, Wintersteen MB, Brown GK, Diamond GM, Gallop R, et al. Attachment-based family therapy for adolescents with suicidal ideation: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry 2010;49:122–31.Search in Google Scholar

98. Habis A, Tall L, Smith J, Guenther E. Pediatric emergency medicine physicians’ current practices and beliefs regarding mental health screening. Pediatr Emer Care 2007;23:387–93.10.1097/01.pec.0000278401.37697.79Search in Google Scholar PubMed

99. Pisani A, Cross W, Gould M. The assessment and management of suicide risk: state of workshop education. Suicide Life Threat Behav 2011;41:255–76.10.1111/j.1943-278X.2011.00026.xSearch in Google Scholar PubMed PubMed Central

100. Rice TR, Sher L. Educating non-mental health care providers about suicide assessment in adolescents. Neuropsychiatry 2012;2:267–70.10.2217/npy.12.33Search in Google Scholar

Received: 2012-8-15
Accepted: 2012-9-20
Published Online: 2013-09-04
Published in Print: 2013-09-01

©2013 by Walter de Gruyter Berlin Boston

Downloaded on 4.6.2023 from
Scroll to top button