Managment of the suicidal risk in Adolescence

Current orientations indicate the necessity to understand suicidality in adolescence as the possible outcome of a decisional process that is not only influenced by known risk factors. To facilitate the clinician to 174 monitor the actual suicidal risk an approach is needed that focuses on the patients’ mental state with respect to thoughts concerning death and suicide. In the present work, we use the Motivational Interview for Suicidality in Adolescence (MIS-A) to evaluate the associations between motivation and suicidality, to establish which motivational contents are associated with a greater suicidal risk in terms of passage to the act, several attempts, and potential lethality of the act. Subjects aged between 12 and 18 years with either active suicidal ideation and/or a recent history of suicide attempts were considered for study inclusion. The overall clinical sample was divided into two clinical subgroups: a) Stay-ideators: subjects who reported suicidal ideation at T1 and did not attempt suicide from three months before to six months after the first evaluation; b) Attempters: subjects who have committed at least one suicide attempt between the three months preceding and the six months following the first evaluation. Data indicates that the MIS categories of interpersonal influence, escape fantasies, impulsivity, and low fear significantly distinguish between ideators and attempters. Only low fear distinguishes between low and high lethality attempters. Clinicians could benefit from a better understanding of how patients process their distress and how they turn it into specific suicidal thoughts within the therapeutic relationship. Seeing the patient as an active human being and not only as someone who is ill, could restore in the therapist a sense of agency and help to manage the feelings of fear that can guide the adolescent care and the management of interventions.