{
  "abstract": "What can we do to prevent suicidal thoughts and behaviours in children and young adults? It is a major cause of death in a number of countries, and in some cases, the incidence is increasing. There appears to be a large literature on randomised clinical trials (RCTs), controlled observational studies and before–after studies of psychosocial interventions, pharmacologic interventions, neurotherapeutics, emerging therapies and combination therapies. How effective are these treatments for preventing suicidal thoughts and behaviours in those at risk for suicide? Sim L et al (JAMA Peds 2025; 179:1217–1224. Doi:10.1001/jamapediatrics.2025.3485) have conducted a systematic review of key databases. Pairs of independent reviewers selected and appraised 65 studies (33 RCTs, 13 comparative observational studies and 19 before–after studies). There was a total of 14 534 patients (median age, 15.1 years; 75.1% female patients) included. There were no studies on pharmacological interventions, which was a surprise to the Archivist, but this illustrates the difficulties of carrying out RCTs on this group of at-risk individuals. None of the studies reported on adverse events. Studies focused on cognitive–behavioural therapy (CBT), dialectical behavioural therapy (DBT), collaborative assessment and management of suicidality, dynamic deconstructive psychotherapy, attachment-based family therapy and family-focused therapy. They also looked at acute crisis management, such as acute psychosocial interventions, such as safety planning, family-based crisis management and motivational interviewing crisis interventions. There were some studies of continuity of care after crisis, and brief adjunctive treatments, and school-based or community-based psychosocial interventions which were social network interventions, school-based skills interventions, suicide awareness or gatekeeper programmes, and community-based, culturally tailored adjunct programmes. DBT was the only one of these interventions with moderate-strength evidence for reducing suicidal ideation. What is DBT? It is a form of CBT, but it focuses on people who have intense emotions and helps the individual understand and accept their difficult feelings, learn skills to manage them and make positive change. All other psychosocial treatments showed insufficient to low strength of evidence for reducing suicidal outcomes. This is quite disappointing. This is a very limited data set. Prichett LM et al (JAMA Peds 2025;179(11): 1151–1152. Doi:10.1001/jamapediatrics.2025.3482) provides an interesting commentary and highlights that it is critical to interpret this uncertainty with care. They discuss the inherent problems associated with the study of suicide prevention, such as difficulty in getting funding and how suicide prevention in clinical practice is constrained by methodological and ethical challenges. Suicide-related outcomes are rare and so the studies need large sample sizes and long follow-up periods. This makes running RCTs difficult and expensive. They remind us that insufficient evidence is not evidence of ineffectiveness and feel that the conclusion of this systematic review should be that many of the studies have methodological limitations that prevent definitive conclusions: small sample sizes, inconsistent outcome measures, limited follow-up periods and variable or poorly described treatment-as-usual comparison groups. So, the challenge is to fund developmentally and trauma-informed treatments, as well as multilevel interventions to target the increasing suicide risk among this age group.",
  "authors": [
    {
      "affiliations": [],
      "name": "BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health"
    }
  ],
  "title": "Suicide prevention in children and adolescents",
  "uid": "dfc13aac-32e5-5bc5-ba98-600c586c41a2"
}