Suicide Prevention Strategies Start With Instilling Hope

What can psychiatrists do, besides treating depression, to keep the 5,000 American youth who commit suicide each year from carrying out such tragic deeds?

The answer may be helping them become more hopeful about life, and even more crucially, helping them to stop blaming themselves for the negative events in their lives and to start giving themselves credit for the good things that happen. Psychiatrists can, for example, help youngsters they treat see that they did not fail a test because they were stupid, or that they did well on a test because of their hard efforts, not because the test was easy.

These recommendations come from a study by Karen Dineen Wagner, M.D., Ph.D., a child psychiatrist at the University of Texas Medical Branch at Galveston, and her coworkers. It was reported in the December 2000 American Journal of Psychiatry.

Wagner and her colleagues studied 50 youngsters hospitalized for various psychiatric diagnoses, including major depression and bipolar disorder, who had suicidal ideas. About half of these young patients had attempted suicide. The researchers used the Children’s Attributional Style Questionnaire, the Hopelessness Scale for Children, and the Children’s Depression Inventory to identify subjects’ mental outlook, level of hope, and amount of depression both at the time of admission and upon discharge—that is, when the subjects were no longer harboring suicidal thoughts.

They then compared the youngsters’ mental outlook, level of hope, and amount of depression at the time of admission with the same factors at the time of discharge. Through this method they expected to gain more insights into the role of the three factors in suicidal ideation.

Not surprisingly, subjects were found to be much less depressed upon discharge than upon admission because during hospitalization they had received medication, psychotherapy, and other treatment appropriate for their illnesses. A reduction in depression in turn undoubtedly helped them relinquish ideas of killing themselves.

More interestingly, however, subjects were found to have become considerably more hopeful during their hospital stay, and this increase in hopefulness appeared to be independent of any changes in depression during that time.

An even more intriguing finding was that subjects were found to have changed their way of thinking about themselves in relation to external events during their hospital stay. In other words, they stopped blaming themselves for negative events in their lives and started taking credit for some of the good things happening to them.

This change in attitude appeared to have occurred independently of any changes in depressive state during the youngsters’ hospitalization and simply to have occurred because of therapists talking with them and helping them put things into perspective.

In fact, this change in attitude may well have been a major reason subjects abandoned their suicidal ideas. Wagner believes that this is the case. In addition, some comments from subjects about why they stopped considering suicide also suggest that this is what occurred.

“This is a significant and helpful study,” David Fassler, M.D., chair of the APA Council on Children, Adolescents, and Their Families, told Psychiatric News. “Wagner and her colleagues have tried to look beyond our existing understanding of suicidal ideation and behavior in children and adolescents. They have added to our understanding of the factors associated with suicidal behavior in this age group. I think their findings may well help us develop new and more effective intervention techniques in helping these children and adolescents.”

Meanwhile, child psychiatrists can already put the findings to use when dealing with suicide-prone youngsters who hold negative views of themselves and the events that affect their lives, Wagner indicated in an interview with Psychiatric News. A psychiatrist can help patients realize that some of their past successes have come to fruition because of their own efforts. A psychiatrist can help patients realize that there are some things that they are good at and that their negative perceptions of themselves are not accurate.

“You try to make inroads into this broad, sweeping view. . .that negative things will happen because of the way they [the patients] are,” she asserted.

Wagner and her colleagues will be following some of the subjects from their study to see whether the more positive outlook they acquired about themselves in the hospital will persist over the long term and, if so, whether that change in outlook might counter suicidal thoughts.

If the answers turn out to be yes, that would be great news indeed for the one in four American adolescents who contemplates suicide each year.

This study, “Cognitive Factors Related to Suicidal Ideation and Resolution in Psychiatrically Hospitalized Children and Adolescents,” is posted on the journal’s Web site at www.ajp.psychiatryonline.org under the December 2000 issue. ▪