Guideline for Assessment and Management of Adolescents with Suicidal Ideation in Primary Health Care

Abstract

Suicide is one of the main causes of death in adolescence globally, and depression, the psychiatric disorder that most often accompanies suicidal ideation, is one of the biggest causes of illness and disability in this population. The detection, approach and referral of high-risk situations by family physicians helps to reduce the risk of suicide in this age group. This guideline was created as part of the coordination between the Department of Child and Adolescent Psychiatry and the primary health care units of the Unidade Local de Saúde de Lisboa Ocidental and aims to systematize and operationalize the approach to adolescents with suicidal ideation seen in primary health care, enhancing early detection and appropriate intervention at the level of risk. This guideline presents definitions of the concepts needed to correctly characterize suicidal ideation and proposes a suicide risk assessment approach, which includes assessing and characterizing suicidal ideation and assessing the risk of committing suicide. Suicide risk assessment culminates in a decision on the referral and treatment of the adolescent, which may consist of immediate referral to the emergency department, a request for a Child and Adolescent Psychiatry consultation or more frequent Family Medicine appointments for reassessment and referral to a Psychology clinic, depending on the level of risk observed. Recommendations for crisis intervention and treatment of identified comorbidities are presented. Early detection and treatment of psychiatric illnesses, intervention in risk factors and restricting access to suicide methods, especially access to medication, stand out as effective measures to prevent suicide in adolescence.