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Psych TopicsChild and adolescent psychiatry — youth self-harm and suicide

Psych · Child and adolescent psychiatry — youth self-harm and suicide

Youth self-harm and suicide

Also known as Adolescent self-harm · Adolescent suicide · Youth NSSI · CAMHS self-harm · Paediatric suicide risk · Child adolescent deliberate self-harm · Teen suicide attempt · Youth safety planning

Exam-exhaustive fellowship reference on youth (child and adolescent) self-harm and suicide — epidemiology, developmental risk and protective factors, NSSI vs suicide attempt on the intent continuum, psychosocial assessment with private youth interview plus family and school interfaces, Gillick/developmental competence and confidentiality limits, safety planning and means restriction without graphic methods, CAMHS disposition pathways, DBT-A and family intervention evidence, antidepressant monitoring context, and non-stigmatising language. Distinct from adult suicide-risk-assessment and adult self-harm-and-crisis-intervention topics. FRANZCP-primary, globally tagged.

high28 referencesUpdated 26 July 202613 min readVerification in progress

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FRANZCPMRCPsychABPNMD-DNBNEET-SS

Red flags

  • Clear intent to die, high expected lethality, preparatory behaviour, or disappointment at survival — treat as elevated near-term suicide risk; do not discharge to an empty plan
  • Ongoing plan with accessible means at home and carers unable or unwilling to secure the environment
  • Escalating NSSI frequency or intensity with emerging suicidal intent, severe hopelessness, or intoxication
  • Safeguarding concerns (abuse, neglect, exploitation, domestic violence) — escalate child-protection pathways; do not treat as 'family conflict only'
  • Command hallucinations, severe psychosis, or acute mania/depression driving self-harm — urgent psychiatric intensity and medical review
  • Stigmatising dismissal as 'attention-seeking', reliance on a no-suicide contract, or promising absolute confidentiality when safety requires carer involvement
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Your progress

Saved on this device.

Practise this topic12 MCQs with explanations

Target exams

FRANZCPMRCPsychABPNMD-DNBNEET-SS

Red flags

  • Clear intent to die, high expected lethality, preparatory behaviour, or disappointment at survival — treat as elevated near-term suicide risk; do not discharge to an empty plan
  • Ongoing plan with accessible means at home and carers unable or unwilling to secure the environment
  • Escalating NSSI frequency or intensity with emerging suicidal intent, severe hopelessness, or intoxication
  • Safeguarding concerns (abuse, neglect, exploitation, domestic violence) — escalate child-protection pathways; do not treat as 'family conflict only'
  • Command hallucinations, severe psychosis, or acute mania/depression driving self-harm — urgent psychiatric intensity and medical review
  • Stigmatising dismissal as 'attention-seeking', reliance on a no-suicide contract, or promising absolute confidentiality when safety requires carer involvement
The one-line answer

Youth self-harm sits on an intent continuum — NSSI, mixed, or suicide attempt. After medical stabilisation, complete a private youth interview plus a family- and school-informed psychosocial assessment, co-create a written safety plan with means restriction, never use no-suicide contracts, and match CAMHS disposition intensity to residual dynamic risk. Hospital-treated self-harm in children and adolescents is a serious long-term risk marker, not attention-seeking.[7][8][17][21]

Meet the patient

A 16-year-old is in the emergency department after taking a paracetamol overdose following a relationship breakup and online bullying. She is tearful, ashamed, and says she "just wanted it to stop". Her mother, frightened and angry, asks whether she is "doing it for attention".[8][9]

The registrar wants a risk score and a decision. The examiner's question is sharper and kinder: "What is the intent here, who else needs to be in the room, and what keeps her safe tonight?" This topic is the structured answer to that question.[13][17]

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References28ShowHide
  1. [1]Cha CB, Franz PJ, M Guzmán E, et al. Annual Research Review: Suicide among youth - epidemiology, (potential) etiology, and treatment J Child Psychol Psychiatry, 2018.PMID 29090457
  2. [2]Bridge JA, Goldstein TR, Brent DA Adolescent suicide and suicidal behavior J Child Psychol Psychiatry, 2006.PMID 16492264
  3. [3]Turecki G, Brent DA Suicide and suicidal behaviour Lancet, 2016.PMID 26385066
  4. [4]Swannell SV, Martin GE, Page A, et al. Prevalence of nonsuicidal self-injury in nonclinical samples: systematic review, meta-analysis and meta-regression Suicide Life Threat Behav, 2014.PMID 24422986
  5. [5]McManus S, Gunnell D, Cooper C, et al. Prevalence of non-suicidal self-harm and service contact in England, 2000-14: repeated cross-sectional surveys of the general population Lancet Psychiatry, 2019.PMID 31175059
  6. [6]Fox KR, Franklin JC, Ribeiro JD, et al. Meta-analysis of risk factors for nonsuicidal self-injury Clin Psychol Rev, 2015.PMID 26416295
  7. [7]Klonsky ED The functions of deliberate self-injury: a review of the evidence Clin Psychol Rev, 2007.PMID 17014942
  8. [8]Hawton K, Bale L, Brand F, et al. Mortality in children and adolescents following presentation to hospital after non-fatal self-harm in the Multicentre Study of Self-harm: a prospective observational cohort study Lancet Child Adolesc Health, 2020.PMID 31926769
  9. [9]Townsend E, Ness J, Waters K, et al. Life problems in children and adolescents who self-harm: findings from the multicentre study of self-harm in England Child Adolesc Ment Health, 2022.PMID 35042280
  10. [10]Owens D, Horrocks J, House A Fatal and non-fatal repetition of self-harm. Systematic review Br J Psychiatry, 2002.PMID 12204922
  11. [11]Geulayov G, Casey D, Bale L, et al. Suicide following presentation to hospital for non-fatal self-harm in the Multicentre Study of Self-harm: a long-term follow-up study Lancet Psychiatry, 2019.PMID 31706930
  12. [12]Kapur N, Steeg S, Turnbull P, et al. Hospital management of suicidal behaviour and subsequent mortality: a prospective cohort study Lancet Psychiatry, 2015.PMID 26254717
  13. [13]Kapur N, Murphy E, Cooper J, et al. Psychosocial assessment following self-harm: results from the multi-centre monitoring of self-harm project J Affect Disord, 2008.PMID 17761308
  14. [14]Posner K, Brown GK, Stanley B, et al. The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults Am J Psychiatry, 2011.PMID 22193671
  15. [15]Large MM, Ryan CJ, Carter G, et al. Can we usefully stratify patients according to suicide risk? BMJ, 2017.PMID 29042363
  16. [16]Franklin JC, Ribeiro JD, Fox KR, et al. Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research Psychol Bull, 2017.PMID 27841450
  17. [17]Stanley B, Brown GK, Brenner LA, et al. Comparison of the Safety Planning Intervention With Follow-up vs Usual Care of Suicidal Patients Treated in the Emergency Department JAMA Psychiatry, 2018.PMID 29998307
  18. [18]Mehlum L, Tørmoen AJ, Ramberg M, et al. Dialectical behavior therapy for adolescents with repeated suicidal and self-harming behavior: a randomized trial J Am Acad Child Adolesc Psychiatry, 2014.PMID 25245352
  19. [19]Mehlum L, Ramberg M, Tørmoen AJ, et al. Dialectical Behavior Therapy Compared With Enhanced Usual Care for Adolescents With Repeated Suicidal and Self-Harming Behavior: Outcomes Over a One-Year Follow-Up J Am Acad Child Adolesc Psychiatry, 2016.PMID 27015720
  20. [20]Kothgassner OD, Goreis A, Robinson K, et al. Efficacy of dialectical behavior therapy for adolescent self-harm and suicidal ideation: a systematic review and meta-analysis Eur Child Adolesc Psychiatry, 2021.PMID 33875025
  21. [21]Ougrin D, Tranah T, Stahl D, et al. Therapeutic interventions for suicide attempts and self-harm in adolescents: systematic review and meta-analysis J Am Acad Child Adolesc Psychiatry, 2015.PMID 25617250
  22. [22]Witt KG, Hetrick SE, Rajaram G, et al. Interventions for self-harm in children and adolescents Cochrane Database Syst Rev, 2021.PMID 33677832
  23. [23]Cottrell DJ, Wright-Hughes A, Collinson M, et al. Effectiveness of systemic family therapy versus treatment as usual for young people after self-harm: a pragmatic, phase 3, multicentre, randomised controlled trial Lancet Psychiatry, 2018.PMID 29449180
  24. [24]Asarnow JR, Berk M, Hughes JL, et al. The SAFETY Program: a treatment-development trial of a cognitive-behavioral family treatment for adolescent suicide attempters J Clin Child Adolesc Psychol, 2015.PMID 25255931
  25. [25]Gould MS, Marrocco FA, Kleinman M, et al. Evaluating iatrogenic risk of youth suicide screening programs: a randomized controlled trial JAMA, 2005.PMID 15811983
  26. [26]Wasserman D, Hoven CW, Wasserman C, et al. School-based suicide prevention programmes: the SEYLE cluster-randomised, controlled trial Lancet, 2015.PMID 25579833
  27. [27]Hetrick SE, McKenzie JE, Bailey AP, et al. New generation antidepressants for depression in children and adolescents: a network meta-analysis Cochrane Database Syst Rev, 2021.PMID 34029378
  28. [28]Meza JI, Zullo L, Vargas SM, Ougrin D, et al. Practitioner Review: Common elements in treatments for youth suicide attempts and self-harm - a practitioner review based on review of treatment elements associated with better outcomes J Child Psychol Psychiatry, 2023.PMID 36878853

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