Practitioner Review: Treatment for suicidal and self‐harming adolescents – advances in suicide prevention care
Abstract
Background: Suicide is a leading cause of death globally in youths, and suicidal behavior and self‐harm are major clinical concerns. This article updates the previous practitioner review (2012) with the aims of integrating new research evidence, including that reported in this Special Issue. Methods: The article reviews scientific evidence related to steps in the care pathway for identifying and treating youths with elevated suicide/self‐harm risk, specifically: (a) screening and risk assessment; (b) treatment; and (c) community‐level suicide prevention strategies. Results: Review of current evidence indicates that major advances have been achieved in knowledge regarding clinical and preventive practices for reducing suicide and self‐harm risk in adolescents. The evidence supports the value of brief screeners for identifying youths with elevated suicide/self‐harm risk and the efficacy of some treatments for suicidal and self‐harm behavior. Dialectical behavior therapy currently meets Level 1 criteria (2 independent trials supporting efficacy) as the first well‐established treatment for self‐harm, and other approaches have shown efficacy in single randomized controlled trials. The effectiveness of some community‐based suicide prevention strategies for reducing suicide mortality and suicide attempt rates has been demonstrated. Conclusions: Current evidence can guide practitioners in delivering effective care for youth suicide/self‐harm risk. Treatments and preventive interventions that address the psychosocial environment and enhance the ability of trusted adults to protect and support youths, while also addressing the psychological needs of youths appear to yield the greatest benefits. Although additional research is needed, our current challenge is to do our best to effectively utilize new knowledge to improve care and outcomes in our communities.
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A recent review shows there is only a limited number of evidence-based treatment options for adolescents, all with limited treatment effects on suicidality.
“A recent review [15] shows that there is only a limited number of evidence-based treatment options for adolescents that all only have limited treatment effects on suicidality, calling for more trials specifically targeting suicidality.”
Cites
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“Others have examined broadly defined self-harming youths (e.g. Mehlum et al., 2014; Ougrin, Boege, Stahl, Banarsee, & Taylor, 2013; Rossouw & Fonagy, 2012), and others have evaluated NSSI (e.g. Miller et al., 2019).”
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Interventions for self-harm in children and adolescents
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van der Spek, N., Dekker, W., Peen, J., Santens, T., Cuijpers, P., Bosmans, G., & Dekker, J. (2024) · Crisis · doi:10.1027/0227-5910/a000916 · Cited by 13 · see citing works
The incubator treatment development model: The SAFETY treatment for suicidal/self-harming youth
Asarnow, J. R., Hughes, J., Cohen, D., Berk, M., McGrath, E., & Huey, S. J. (2022) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2020.09.012 · Cited by 10 · see citing works
Self-citationAsking Preadolescents About Suicide Is Not Associated With Increased Suicidal Thoughts
Hennefield, L., Luking, K. R., Tillman, R., Barch, D. M., Luby, J. L., & Thompson, R. J. (2026) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2025.03.025 · Cited by 8 · see citing works
“6,7 Despite the push for expanded screening, and the evidence that suicide-risk screening effectively identi fi es at-risk youth, 8,9 there are unique challenges and concerns about potential risks associated with suicide-risk screening in T preadolescents.”
Bockting, C., Bosmans, G., Bergers, N., Gavan, L., Hiligsmann, M., de Beurs, D., Molenberghs, G., Wijnen, B., Lokkerbol, J., & van der Spek, N. (2024) · Trials · doi:10.1186/s13063-024-08499-7 · Cited by 1 · see citing works
“There is increasing evidence that points at the importance of working with families and addressing the unmet need for belonging and perceived burdensome-ness when targeting youth suicidality [15–19].”
Background
- Authors
- Asarnow, J. R., & Mehlum, L.
- Affiliations
- University of California, Los Angeles (US)
- University of Oslo (NO)
- Corresponding author
- Asarnow, Joan Rosenbaum
- Venue
- Journal of Child Psychology and Psychiatry
- Publisher
- Wiley
- Published
- 2019-09-12
- Volume
- 60
- Issue
- 10
- Pages
- 1046-1054
- ISSN
- 0021-9630 (ISSN-L)
- 1469-7610
- OpenAlex
- W2972776841
- Cited by
- 100
- References
- 46
- Citations by year
- 2026: 7 · 2025: 18 · 2024: 15 · 2023: 20 · 2022: 12 · 2021: 17 · 2020: 10 · 2019: 1
- FWCI
- 1.57
- Type
- journal article
- Language
- en
- Update notices
- correction (2019-11-13)
- Open access
- closed
- Locations
- Journal of Child Psychology and Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (NIMHR01, MH112147)
- Substance Abuse and Mental Health Services Administration (SAMHSA U79SM080041)
- American Foundation for Suicide Prevention
- American Psychological Association
- Society of Clinical Child and Adolescent Psychology
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Keywords
- adolescent suicide, self-harm, suicide prevention, suicide risk assessment, suicide risk screening, dialectical behavior therapy, brief intervention, suicide attempt prevention, youth mental health care
- MeSH terms
- Suicide Prevention, Adolescent, Behavior Therapy, Humans, Self-Injurious Behavior, Risk Assessment
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