Continuing Education Activity

Suicidality among children and adolescents represents a critical and growing public health concern, with rising rates of ideation and behavior contributing to significant morbidity and mortality. Clinical prediction at the individual level remains limited, necessitating standardized approaches to identification and management across care settings. This activity reviews developmental patterns, key risk factors, and evidence-based strategies for screening and assessment using structured tools. Emphasis is placed on a 3-step clinical pathway involving brief screening, focused suicide safety assessment, and risk-based disposition planning. The participant learns to apply validated frameworks to improve early detection, ensure appropriate intervention, and support safe transitions of care. Collaboration among an interprofessional team—including clinicians, nurses, mental health specialists, and social workers—enhances care coordination, facilitates timely referral, strengthens safety planning, and improves follow-up, ultimately leading to better patient outcomes and reduced suicide-related risk.

Objectives:

• Identify demographic, psychological, and clinical risk factors associated with suicide in children and adolescents.
• Assess the level of suicide risk in children and adolescents through the use of brief, structured safety screening and assessments to determine next steps.
• Determine appropriate interventions to mitigate risk factors and strengthen protective factors identified in a suicide risk assessment of a child or adolescent patient.
• Implement evidence-based interprofessional team strategies to improve care coordination and communication during the screening, evaluation, and management of suicidality in children and adolescents.

Introduction

Suicide is a leading cause of death among adolescents and young adults and a major public health concern. No single risk factor or set of risk factors is sufficiently specific to predict suicide accurately at the individual level.[1][2] According to the World Health Organization, Suicide Worldwide in 2019: Global Health Estimates, suicide is the fourth leading cause of death among adolescents and young adults aged 15 to 29 years. 

In the United States, suicide was the second leading cause of death among 10- to 24-year-olds between 2011 and 2020,[3] with the suicide rate increasing 52.2% between 2000 and 2021. In 2021, suicide was the fifth leading cause of death for children ages 5 to 12.[1] Suicidal thoughts and behaviors can present across multiple clinical settings, including primary care, pediatrics, specialty clinics, and emergency departments. Healthcare professionals play a critical role in identifying and managing suicide risk in children and adolescents.

A key barrier to suicide risk screening is uncertainty about how to manage patients who screen positive. Every clinical setting requires a clear, standardized plan to manage patients who screen positive, as uncertainty about next steps remains common among clinicians. Effective suicide risk management requires early identification, structured assessment, timely intervention, and safe disposition planning. Effective implementation of screening requires leadership support, clear clinical workflows, appropriate resources, and provider education.[4] 

A longitudinal study of children oversampled for depression (recruited at ages 3–6 and followed through age 17) identified three trajectories of suicidal thoughts and behaviors.[5] A majority of the children had consistently low levels of suicidal thoughts and behaviors. Another group (6.7%) was labeled "early-persistent" and had ongoing and increasing levels of suicidal thoughts and behaviors into late adolescence.

A third group (also about 6.7%) was considered "late onset," and had low levels of suicidal thoughts and behaviors until about age 10 years, then had a significant increase in suicidal thoughts and behaviors from ages 11 to 14 years.[5] Depressive symptoms, externalizing behaviors (eg, oppositional defiant behaviors, conduct problems, hostility, and relational aggression),[6] impulsivity, and lower income in preschool children were associated with both high-risk groups.[5] About half of adolescents with suicidal thoughts and behaviors first exhibited suicidality in early childhood.[5] The primary distinguishing factor between the two high-risk groups was poorer academic functioning in the late-onset group.[5] These results emphasize the potential for early intervention starting in the preschool years and challenge the notion that suicidal thoughts and behaviors are limited to adolescents and adults.[1] 

Suicide is among the most common sentinel events.[7] In 2019, the Joint Commission issued recommendations related to national patient safety goals for suicide prevention,[8] including environmental risk assessment, validated suicide risk assessment tools, and safe discharge planning. The United States Department of Health and Human Services identified the reduction of suicide rates as a priority area in Healthy People 2030. The American Academy of Pediatrics recommends that pediatricians screen patients 12 years and older for suicide risk at least annually.[9]

The National Institute of Mental Health Youth Ask Suicide-Screening Questions (ASQ) Toolkit is a free resource that helps clinicians identify youth at risk for suicide and provides evidence-based clinical pathways for intervention. Screening and assessment are distinct processes: screening identifies individuals who need further evaluation, while assessment provides a comprehensive risk evaluation to guide next steps.[10] 

A practical clinical pathway for suicide risk management includes 3 steps:

• Brief screening for suicide risk (about 20 seconds)
• Brief suicide safety assessment for patients who screen positive (about 10 minutes)
• Determining the appropriate disposition for patients who screen positive

Brief Screening for Suicide Risk 

The ASQ is a 4-item yes/no screening tool that takes approximately 20 seconds to administer and is designed for use by nonpsychiatric clinicians. In one National Institute of Mental Health study, a “yes” response to 1 or more of the 4 ASQ questions identified 97% of youth aged 10 to 21 years at risk for suicide; this finding has been replicated in other studies.[11] Barriers to screening include concerns that asking about suicide may increase distress, worries that referral of patients with positive screens will disrupt workflow, and concerns about negative patient reactions. Asking about suicide risk does not cause iatrogenic harm.[12]

Most people who die by suicide have contact with a healthcare provider before their death. There is a significant opportunity to identify youth at risk and link them to mental health resources. The Joint Commission recommends suicide risk screening in medical settings, particularly for patients presenting with behavioral health concerns or risk indicators. Healthcare providers can use validated suicide risk screening tools to identify youth who need further evaluation or intervention. Other evidence-based screening tools include the Columbia-Suicide Severity Rating Scale (CSSRS), the Suicidal Ideation Questionnaire (SIQ), and the Risk of Suicide Questionnaire (RSQ). These screening tools uncovered suicide risk in about 20% of medical/surgical patients and about 50% of psychiatric patients in pediatric emergency departments.[13]

Brief Suicide Safety Assessment for Patients Who Screen Positive

Children and adolescents who screen positive on the ASQ should have a Brief Suicide Safety Assessment (BSSA) to clarify their risk severity. This is not a full psychiatric evaluation. It is a brief, structured assessment that typically takes 10 to 15 minutes to clarify acuity and guide disposition. The National Institute of Mental Health ASQ Toolkit provides scripts and worksheets for use across multiple settings, including emergency departments, inpatient medical and surgical units, and outpatient settings. Primary care clinicians play a key role as an initial point of contact for many at-risk youth.[14]

Determining a Course of Action/Disposition

Clinicians across different healthcare settings can identify suicide risk and connect patients to further mental health care. The BSSA identifies 3 general risk scenarios that guide next steps in caring for a child or adolescent with suicidal ideation or suicidal behavior:

• Patients at imminent risk or with acute positive screens need emergency psychiatric and safety evaluations; clinicians are obligated to ensure the patient's safety.
• Patients who are at moderate risk or require further evaluation need a prompt, comprehensive assessment from a mental health professional and interventions such as a safety plan, lethal means safety counseling, and access to crisis resources.
• Patients at mild risk may not require urgent further evaluation but may benefit from mental health follow-up, safety planning, and crisis resources such as the 988 Suicide and Crisis Lifeline.[12]

Etiology

Vulnerability to suicide may be influenced by factors operating early in life, from the prenatal period through childhood. There is evidence consistently supporting links between sociodemographic, obstetric, parental, and child developmental factors during early childhood and a higher risk of death from suicide:

• Sociodemographic factors include young maternal age, paternal age at either extreme, single-parent household status, low parental educational attainment, later born order, immigration status, adoptee status, residence in institutional care, and contact with social services.
• Pregnancy/birth factors include low birth weight, low birth length, birth-related trauma, being born in the Spring, and maternal smoking during pregnancy.
• Parental and child factors include parental death, parental stressors, parental disability, childhood health problems, traumatic brain injury, and adverse emotional experiences.[15]  

Family and twin studies show that both suicide attempts and suicide are heritable. In a case-control study using Danish National Registry data and the iPSYCH2015 case-cohort data set, a broad range of health conditions and genetic factors were associated with increased risk of both suicide attempts and suicide.[16] Another study showed the heritability of suicide attempts was stronger in people aged between 10 and 24 than in people aged 25 and older. The genetic correlation for suicide attempt during youth and adulthood was stronger for women. The study concluded, "The genetic and environmental etiologies of suicide attempt and death are partially overlapping, exhibit modest sex differences, and shift across the life course."[17]

In adolescents, a prior history of attempted suicide, active suicidal ideation, and having a psychiatric disorder are predictors of attempted suicide, although the magnitude of the extent varies widely.[18][19] Two other risk factors predictive of suicidal behavior during adolescence are a history of child abuse [20][21] and having a family member or peer who died of suicide.[22] 

Epidemiology

According to the World Health Organization, Suicide Worldwide in 2019: Global Health Estimates, suicide was the fourth leading cause of death among adolescents and young adults aged 15 to 29 years. Southeast Asia had the highest suicide rate among the 6 WHO regions.[23] In the United States, the suicide rate increased 52.2% between 2000 and 2021, and suicide was the second leading cause of death among 10- to 24-year-olds between 2011 and 2020.[3]

In 2021, it was the fifth leading cause of death for children ages 5 to 12.[1] Suicide attempts were more common in female adolescents, but deaths were more common in male adolescents, who often used more lethal means. The leading methods of suicide in 2020 for 10- to 24-year-olds were firearms (51%), suffocation (33.5%), and overdose/poisoning (5.9%).[3] The epidemiology of suicide is complicated by the fact that most suicides do not occur in high-risk groups.

These analyses do not fully reflect youth suicide during the COVID-19 pandemic and its aftermath. Issues such as decreased social connectedness and peer interactions, and family-related difficulties, such as financial problems, mental health problems in family members, and poor parenting, may have increased rates of youth suicide during and after the pandemic.[23] Children younger than 10 years are generally excluded from age group categories because suicidal intent can be difficult to ascertain in young children.[24]

Analyses demonstrate differences in suicide rates based on race and ethnicity and age group in the context of overall suicide rates nearly returning to their 2018 peak after 2 years of declines. Rates among persons aged 10 to 24 years increased significantly from 2018 to 2021 among Black persons (from 8.2 to 11.2; a 36.6% increase).[25] Suicide attempts have increased among Black and Hispanic youths.[26] 

A 2025 study of 3 large, diverse adolescent cohorts in the United States showed that, despite differences in age and ascertainment methods in each cohort, Black girls experienced the highest rates of suicidal ideation and suicide attempts in comparison to Black boys, White girls, and White boys.[27] In 2019, almost 1 in 10 high school students reported at least 1 suicide attempt.[28] More than 80% of children who attempt suicide are not identified by pediatricians in a routine visit months before the suicide attempt.[29][30]

Pathophysiology

The biological mechanisms and pathophysiology of suicide are unclear. There are few studies of the pathophysiology of suicide in children and adolescents, and youth is a time of significant plasticity in neural development as well as the hormonal changes that occur with the onset of puberty. A 2022 study of 91 children and adolescents aged 13.9 +/- 2.4 years noted that high neutrophil/lymphocyte ratios and high platelet/lymphocyte ratios may be associated with suicidal behavior in depressed and anxious children and adolescents, with the neutrophil/lymphocyte ratio appearing as a better predictor of suicide attempts. The neutrophil/lymphocyte ratio may be a useful biomarker of suicidality in this cohort.[31]

In a cohort study of 8807 participants published in 2024, parent-reported disturbed sleep (especially nightmares and daytime somnolence) at age 10 years was associated with increased risk for suicidal ideation and suicide attempts in the next 2 years.[32] The main finding of a 2025 study was that shorter total time in bed on school days and more frequent night awakenings at age 14 were associated with an increased likelihood of reporting attempted suicide at 17 years.[33] Preadolescents who experienced advanced puberty at age 9 and 10 years were more likely to have experienced self-injurious thoughts and behaviors, SITB (suicidal ideation, suicide attempts, and nonsuicidal self-injury), and if SITB naive, were more likely to experience the onset of SITBs over the next 2 years.[34]

History and Physical

The Suicide Risk Screening clinical pathway for managing suicide risk in children and adolescents was developed by the American Academy of Child and Adolescent Psychiatry (AACAP) Pathways for Clinical Care workgroup and can be described in 3 basic steps:

1. Brief screening for suicide risk (ideally separate from parents) by administering the ASQ (about 20 seconds)
2. BSSA for patients who screen positive (about 10 minutes)
3. Determining a course of action for patients who screen positive and connecting individuals to the appropriate level of mental health care [4] 

Brief Screening for Suicide Risk

The purpose of a brief screening for suicide risk is to identify child and adolescent patients at risk for suicide rapidly. Evidence-based screening tools include the ASQ, which has been validated for use in medical settings with children and adolescents aged 10 to 24 years. If younger children have psychiatric or behavioral difficulties, it may be advisable to screen them. The Joint Commission approves the use of the National Institute of Mental Health Youth ASQ Toolkit. For patients who are not medically stable, screening should be done when they are medically stable. The screening should be conducted early in the workflow, and parents/guardians should be asked to step out briefly, as the patient may be less likely to be frank when they are present. 

The ASQ Suicide Risk Screening Tool

Ask the patient:

1. In the past few weeks, have you wished you were dead?
2. In the past few weeks, have you felt that you or your family would be better off if you were dead?
3. In the past week, have you been having thoughts about killing yourself?
4. Have you ever tried to kill yourself? If yes, how? When?

If the patient answers "No" to the first 4 questions, the screening is complete; no intervention is necessary, and question #5 need not be asked. Note that clinical judgment can always override a negative screen. If the patient answers "Yes" to any question or refuses to answer, they are considered to have a positive screen, and the screener then asks question #5 to assess acuity.

5. Are you having thoughts of killing yourself right now? If yes, please describe.

If the patient answers “Yes” to question #5, it is considered an acute positive screen with imminent risk for suicide identified. The patient requires an immediate safety/full mental health evaluation and cannot leave until evaluated for safety. Keep the patient in sight, remove all dangerous objects from the room, and alert the physician or clinician responsible for the patient’s care.

If the patient answers “No” to question #5, it is considered a non-acute positive screen with potential risk identified. The patient requires a BSSA to determine if a full mental health evaluation is needed. If the patient or guardian refuses further assessment after a positive screen, the responsible clinician should be notified immediately, and institutional policies for refusal, discharge, and safety escalation should be followed.

Brief Suicide Safety Assessment for Patients Who Screen Positive

Patients who screen positive should undergo a BSSA to determine risk acuity and guide next steps. This is a brief, structured assessment (typically 10–15 minutes) and is not a full psychiatric evaluation. The National Institute of Mental Health Youth ASQ Toolkit provides structured scripts and worksheets for use in emergency, inpatient, and outpatient settings. The Columbia Suicide Severity Rating Scale (CSSRS) BSSA can also be used.

The BSSA should be performed by trained clinicians, including physicians, psychologists, nurse practitioners, physician assistants, or licensed clinical social workers:

1. Explain your role and acknowledge the patient’s willingness to discuss their thoughts.
2. Assess the patient privately when possible, and review the ASQ responses.
3. Assess:Suicidal thoughts (presence, frequency, intensity)Plan and intentPrior attempts or self-injuryPsychiatric symptoms, substance use, and stressorsProtective factors and supportsObtain collateral information when possible.
4. Thank the patient for their participation.
5. Interview the parent or guardian separately to obtain collateral information, including prior suicidal thoughts or behaviors, current symptoms, safety at home, and engagement in mental health care.[4] 

Evaluation

No laboratory, radiographic, or other tests are required to evaluate suicidality; clinically appropriate tests should be obtained. Substance use, including alcohol use, is an important risk factor for suicidal thoughts and behaviors. Toxicology testing should be obtained when clinically indicated, particularly when intoxication or ingestion is suspected.

Treatment / Management

Determining a Course of Action/Disposition

The BSSA has 3 possible scenarios (BSSA Pathway for the emergency department) that guide the next steps in treating a patient who has revealed suicidal ideation or engaged in suicidal behavior:

• Patients at imminent risk or with acute positive screens require emergency psychiatric and safety evaluations. Clinicians are responsible for ensuring patient safety.
• Patients who are at moderate risk or need further evaluation need a prompt, comprehensive evaluation from a mental health professional and interventions such as a safety plan, lethal means safety counseling, and access to crisis resources.
• Patients at mild risk may not require further evaluation. Still, they may benefit from mental health follow-up and developing a safety plan, as well as receiving a list of resources, such as the 988 Suicide and Crisis Lifeline number.[12]

After completing the BSSA, the clinician chooses the appropriate disposition plan:

1. Emergency psychiatric evaluation: The patient is at imminent risk for suicide with current suicidal thoughts. If inpatient, keep the patient safe, remove dangerous objects, have continuous observation, and request an emergency psychiatric evaluation. If outpatient, send the patient to the emergency department for an urgent mental health evaluation; assessment of risk to others should be included when clinically indicated.
2. Further risk evaluation is necessary: If the patient is an inpatient in a medical or surgical unit, a comprehensive mental health and safety evaluation must be requested before discharge. If the patient is an outpatient, review the safety plan and send home with a mental health referral as soon as possible, preferably within 72 hours.
3. The patient may benefit from a non-urgent mental health care follow-up: review the safety plan.
4. No further intervention is necessary at this time.
5. Provide resources to all patients (National Suicide Prevention Lifeline [988] and the Crisis Text Line: Text "HOME" to 741741).

Provision for a safe environment, careful screening and assessment, optimal patient visibility, appropriate patient supervision, and proper clinical treatment are some of the strategies to reduce suicide risk in inpatient units.[4] 

Suicide Interventions

A systematic review of available treatments for suicidal thoughts and behaviors that included 65 North American studies found that current evidence on available treatments is uncertain.[35] Despite limitations in the evidence base, clinicians should not defer screening, safety planning, means-restriction counseling, and linkage to follow-up care. Clinicians should continue to screen, treat, and engage in safety planning, informed by comparative effectiveness, professional expertise, and the values, preferences, and social context of patients and their families.[35] Moderate-strength evidence suggests that dialectical behavior therapy (DBT) may reduce suicidal outcomes. Other possible psychosocial interventions are:

• Psychotherapy interventions: cognitive behavioral therapy, collaborative management of suicidality, deconstructive psychotherapy, attachment-based family therapy, and family-focused therapy
• Acute psychosocial interventions: safety planning, family-based crisis management, motivational interviewing crisis interventions, continuity of care after crisis, and brief adjunctive treatments
• School- or community-based psychosocial interventions: social network interventions, school-based skills interventions, suicide awareness or gatekeeper programs, and community-based, culturally tailored adjunct programs
• Intensive outpatient or partial hospitalization programs
• Residential or inpatient services

Pharmacologic treatments and neurotherapeutics to reduce the risk of suicide are not well-studied in children and adolescents.[35] Gaps in evidence should not be misread as a lack of efficacy, and clinicians should continue to follow expert guidance from organizations such as the American Academy of Pediatrics, which recommends the use of safety planning, lethal means counseling, access to therapy, and care coordination (Blueprint for Youth Suicide Prevention).

Differential Diagnosis

The differential diagnoses for suicidality include:

• Obsessive-compulsive disorder (OCD): Youth with OCD may describe intrusive egodystonic thoughts about suicide, find these thoughts distressing, and not want to act on them.
• Nonsuicidal self-injury (NSSI): Behaviors related to self-inflicted injury, such as nonsuicidal cutting, burning, and scratching, without lethal intent.[3]
• Childhood maltreatment and posttraumatic symptoms: Individuals may contemplate suicide as an escape.
• Grief and bereavement: Some individuals may report thoughts of wanting to "join" a recently deceased loved one, particularly after a significant loss.
• Substance overdose: Substances may increase the risk of suicide due to impaired judgment and lower inhibitions, but may also unintentionally increase the risk for death via overdose.[3]

Pertinent Studies and Ongoing Trials

A study proposed by Fatt and colleagues plans to map inflammatory profiles to suicidal behavior and establish an immune signature of suicide risk to guide future research into pathophysiology, as well as guide clinical screening, risk management, and future research.[36] The Texas Youth Depression and Suicide Research Network Participant Registry Study was initiated in 2020 to develop predictive models for treatment outcomes in youth with depression and/or suicidality.[37] The infrastructure for studying youth suicide is limited due to poor funding, methodological and ethical challenges, and the rarity of high-quality trials. Suicide is rare; therefore, large sample sizes and long follow-up times are needed, making research difficult.[38]

Prognosis

Youth suicidality is complex, and there are diverse outcomes for those who have attempted suicide. A 6-year study that followed adolescents from school into early adulthood found that the individuals who attempted suicide before the age of 14 years and repeated suicidal acts between ages 14 and 15 years had worse prognostic profiles. Males who attempted suicide had a better psychiatric prognosis than females who attempted suicide.[39]

A 2022 study used a population-based longitudinal sample to estimate future well-being among youth who survived a suicide attempt, and found that 1 in 7 youth (approximately 13%) who survived a suicide attempt reported high well-being seven years later, as compared to about 1 in 4 peers who reported no suicidal ideation at earlier and later waves. The study concluded that a non-fatal suicide attempt, despite signaling distress, did not preclude high levels of future well-being in a significant subgroup of youth.[40] A 2025 study of national trends in suicidal thoughts among United States high school students demonstrated broad increases in suicidal thoughts and attempts from 2007 to 2021. Crucially, suicidal symptoms "increased as much among students with few or no behavioral risks as among students with multiple risks, underscoring the need to find better ways of identifying students with suicidal symptoms."[41] 

Complications

Over the past 2 decades, the health of children and adolescents in the United States (US) has worsened across multiple health indicators. Children and youth were 80% more likely to die than their counterparts in other high-income countries. The leading causes of death among the 1- to 19-year-old age group were motor vehicle crashes, substance use, and homicide.

During the study period, rates of obesity, early onset of menstruation, trouble sleeping, limitations in activity, physical symptoms, depressive symptoms, and loneliness all increased. In 2020, firearm deaths became the leading cause of death among children and youth in the US.[42] In this context of worsening health, it is important to assess patients for medical conditions and active substance use. Environmental and societal stressors, including climate-related disruptions, may contribute to psychological distress and suicide risk.[43]

LGBTQ+ youth experience higher rates of suicidal ideation and behavior than their cisgender, heterosexual peers, and are affected by persistent minority stress, according to Project SPARK Interim Report: A Longitudinal Study of Risk and Protective Factors in LGBTQ+ Youth Mental Health. Anti-transgender laws increased past-year suicide attempts among transgender and non-binary young people ages 13 to 17 in the United States by 7% to 72%, highlighting the need to consider the mental health impact of such legislation.[44] The American Foundation for Suicide Prevention provides resources for families affected by a suicide attempt or suicide death.

Consultations

Consultation with psychiatry may help with complex cases and in establishing diagnoses and treatment plans, especially when there are co-occurring disorders that may exacerbate suicidal ideation. When risk formulation or disposition is uncertain, consultation with a psychiatrist or another qualified mental health clinician is advisable. When providing a second opinion, the consulting psychiatrist or mental health professional should carefully review the medical record, evaluate the patient, and document the consultation in the medical record.[45]

Deterrence and Patient Education

Clinical Interventions

If the patient is at low or moderate risk, a clinical staff member or behavioral health clinician can create a safety plan with the patient. The safety plan can include (but is not limited to):

• Warning signs
• Things the patient can do to take their mind off their problems
• People and social settings that provide distraction
• People whom the patient can ask for help during a crisis
• Professionals or agencies the patient can contact during a crisis, including the local emergency department, the national 988 Suicide and Crisis Lifeline, and the Crisis Text Line: Text "HOME" to 741741
• Plan for lethal means safety [46]

A sample safety plan is the Stanley-Brown Safety Plan.

Universal Prevention 

A public health framework is necessary to reduce access to lethal means, advocate for mental health parity, implement health-system-wide prevention strategies, expand access to care, train school staff and healthcare workers, promote safe social media use, and acknowledge lived experience.[26]

Pearls and Other Issues

Pearls and other issues include the following:

• Healthcare professionals are obligated to ensure patient safety.
• A 3-step process of screening, assessment, and disposition provides a structured approach to suicide risk management.
• Substance use, particularly alcohol use, is a risk factor for suicide, and toxicology testing should be obtained when clinically indicated.
• If the patient is at imminent risk for suicide with current suicidal thoughts: If inpatient, keep the patient safe, remove dangerous objects, have continuous observation, and request an emergency psychiatric evaluation; if outpatient, send to the emergency department for a mental health evaluation, which should also include an assessment as to whether the patient is a danger to others.
• High lethality suicide methods include firearms and suffocation.
• A suicide risk assessment is distinct from suicide screening instruments in that an assessment requires clinical reasoning on the extent to which protective factors and various forms of clinical intervention can mitigate suicide risk; the complex interplay of these areas, weighed by clinical judgment, determines disposition and treatment.
• Advocate for increased research on suicide prevention and for adequate payment for providing suicide risk screening and assessment services, as well as mental health care.
• Gaps in evidence should not be misread as a lack of efficacy, and clinicians should continue to follow expert guidance from organizations such as the American Academy of Pediatrics, which recommends including the family in suicide prevention and treatment efforts, the use of safety planning, lethal means counseling on safe firearm and medication storage, access to therapy and mental health professionals, and care coordination (Blueprint for Youth Suicide Prevention).

Enhancing Healthcare Team Outcomes

A key barrier to effective suicide risk screening is uncertainty about how to manage patients who screen positive. Each clinical setting should implement a clear, standardized pathway that includes screening, brief safety assessment, and appropriate disposition to ensure timely and consistent care. Effective suicide risk management requires coordinated efforts across the healthcare team. Clinicians, nurses, social workers, psychologists, and other clinicians play essential roles in identifying risk, conducting assessments, implementing safety planning, and facilitating appropriate follow-up. Clear communication and defined roles within the team improve workflow efficiency and patient safety.

Clinicians should use nonjudgmental, supportive communication and avoid stigmatizing language when discussing suicidal thoughts and behaviors. Training in suicide risk assessment, safety planning, and lethal means counseling is essential to improve clinician confidence and reduce variability in care. Mindfulness and compassion training may help staff create a safe, nonjudgmental space, build trust with patients, and keep them engaged, according to the American Medical Association Suicide Prevention How-To Guide.

Healthcare systems should support suicide prevention efforts through leadership engagement, staff training, standardized protocols, and access to mental health resources. Integration of behavioral health services and streamlined referral pathways can reduce delays in care and improve outcomes. The impact of patient suicide on healthcare providers can be significant and may include emotional distress, anxiety, and self-doubt.

Structured debriefing, peer support, and access to mental health resources are important components of postvention care for healthcare teams. Institutions should have protocols in place to support clinicians following a patient suicide. The New York State Office of Mental Health’s Suicide Prevention Center guide, THE IMPACT OF SUICIDE ON PROFESSIONAL CAREGIVERS: A Guide for Managers and Supervisors, includes how to address grief, debriefing staff, supporting those affected by the death, and contact with family and other survivors of the suicide loss.

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Disclosure: Susan McNamara declares no relevant financial relationships with ineligible companies.

Disclosure: Kamakshya Patra declares no relevant financial relationships with ineligible companies.

Disclosure: Sunny Aslam declares no relevant financial relationships with ineligible companies.