New Approaches to the Assessment and Treatment of Suicidal Adolescents

The special section of this issue addresses one of our most intractable problems in pediatric psychiatry: Suicide and suicidal behavior. We are very pleased that the articles included offer some promising insights and possible approaches that may inform the clinician as she or he gives care to at-risk adolescents. And furthermore, we are encouraged that the authors look at this societal issue with a broad lens, recognizing the myriad factors that can contribute to self-injurious behavior—and often providing us new vantage points that will hopefully lead to better preventative measures.

Yen et al. offer a good example of our evolving “tool box” for addressing and perhaps countering suicidal behavior and self-harm in the clinical population. Their measure of “perceived family and peer invalidation” and its predictive value in an at-risk population—particularly for suicidal events in males, and self-injury in females—is worthy of close consideration and further development. But perhaps the core idea of this construct is that it lays the groundwork not only for further studies but for more nuanced care at the individual level.

Ackerman et al. provide a welcome empirical window into a phenomenon well known to clinicians: The impulsivity of suicide attempters. The authors' use of a gambling task in this study identifies a deficit in “risk-sensitive decision-making” in this population. Furthermore, this study compels clinicians to look beyond psychiatric diagnosis, by concluding that “attempted suicide is associated with an increased risk-taking propensity that may place individuals at risk beyond psychopathology alone.”

Whereas the above-noted articles lay the groundwork for future advances in assessment and intervention, Goldstein et al. is directly addressing whether psychosocial interventions can reduce suicidal risk in a group known to be at extraordinarily high risk for suicidal behavior, namely bipolar youth. The authors' pilot study suggest that dialectical behavior therapy (DBT) in conjunction with medication management is a promising intervention for reducing suicidal risk through enhancing emotion regulation and “commitment to treatment.”

There are several other exciting offerings in this special section that warrant your careful scrutiny. Taken as a collective whole, these articles should give investigators and clinicians hope that, with further work in studying protective factors, etiopathogenesis, and novel interventions, we can save lives and reduce the public health burden of lost years of life to youth suicide. Thank you to all of you, our contributors, and devoted readers.