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Clinical Pearls Video Series: Suicidal and Non-Suicidal Self-Injurious Behavior

Video Chapters

Click on the three lines in the upper left corner to see chapter information or reference the chapter table of contents below to navigate to specific chapters.

  • Assessment
    • Is it important to assess for suicide risk in patients presenting to primary care practice? (0:08–2:55)
    • What do I do if there is a positive screen given I am in a busy practice? (2:56–5:02)
    • How do I talk to families about suicide, firearms, other lethal means, their restriction, and suicide risk? (5:03–6:29)
  • Management
    • How do I know if it is safe to send a child home who has suicidal ideation or self-injury? (6:30–8:17)
    • How do I treat a patient presenting with suicidal risk? What are the evidence-based therapies and what is the role of medication? (8:18–13:40)
    • What do I do if I cannot get access to timely mental health services for my patient who is at-risk for suicide? (13:41–14:52)
  • Key Takeaways (14:53–16:17)
photo of Dr. Alejandra Arango Alejandra Arango, Ph.D., Child Psychologist, University of Michigan

Suicide is a preventable public health tragedy and the leading cause of death among youth ages 10-24 in the United States.

A notable proportion of youth experience suicidal thinking or have a history of engagement in suicidal and/or non-suicidal self-injurious (NSSI) behaviors.

  • Approximately 22% of US high school students report that they seriously considered making a suicide attempt, while 10% report having made a suicide attempt in the past year (CDC, 2023).
  • The past year prevalence of NSSI is also estimated to be high among adolescents (~23% in a non-clinical sample). 

Suicide risk notably increases in the transition into adolescence. There is evidence for an increase in suicide risk among subgroups of adolescents (e.g., biological females, Black and Hispanic youth).

  • Additionally, sexual and gender minority youth report elevated suicidal ideation and behaviors and are at particularly high risk for suicide.
  • Suicide risk and protective factors span demographic characteristics (e.g., biological sex, gender, age, race/ethnicity), psychopathology (e.g., depression), interpersonal stressors (e.g., peer victimization, social connectedness), as well as a history of self-harm thinking and behaviors.

NSSI includes self-harm behaviors (e.g., cutting, burning) without suicidal intent. Functions of NSSI are varied and may include communication of distress, escape from a situation or emotions, a desire to feel in control, wanting to reduce feelings of numbness, self-punishment, and intent should always be clarified.

Emergency department (ED) visits due to suicide attempts and other suicidal behavior have been climbing in the past few years, especially among girls.

  • Notably, ED visits due to self-harm behaviors have notably increased in recent years.
  • Among youth, under 19, who died by suicide, approximately 38% and 77% had contact with the healthcare system in the month and year prior to their death, respectively.

Primary care settings present a unique and critical opportunity to identify and intervene with youth at risk for suicide or who are engaging in NSSI.

Resources Mentioned in the Video

Screening Tools

Other Resources

Ahmedani BK, Simon GE, Stewart C, Beck A, Waitzfelder BE, Rossom R, et al. Health care contacts in the year before suicide death. J Gen Intern Med. 2014;29(6) 870-877. https://doi.org/10.1007/s11606-014-2767-3 

Centers for Disease Control and Prevention. WISQARS. 10 Leading Causes of Death, United States, 2018-2020. https://wisqars.cdc.gov/data/lcd/home

Centers for Disease Control Prevention. (2023). Youth Risk Behavior Survey Data Summary & Trends , 2011–2021. https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBS_Data-Summary-Trends_Report2023_508.pdf 

Cha CB, Franz PJ, Guzmán EM, Glenn CR, Kleiman EM, Nock MK. Annual Research Review: Suicide among youth–epidemiology, (potential) etiology, and treatment. J Child Psychol Psychiatry. 2018;59(4):460-482. https://doi.org/10.1111/jcpp.12831 

Gaylor EM, Krause KH, Welder LE, Cooper AC, Ashley C, Mack KA, et al. Suicidal thoughts and behaviors among high school students—Youth Risk Behavior Survey, United States, 2021. MMWR supplements. 2023;72(1):45. https://doi.org/10.15585/mmwr.su7201a6 

Haas AP, Eliason M, Mays VM, Mathy RM, Cochran SD, D’Augelli AR, et al. Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: Review and recommendations. J Homosex. 2011;58(1):10-51. https://doi.org/10.1080/00918369.2011.534038 

Nock MK, Green JG, Hwang I, McLaughlin KA, Sampson NA, Zaslavsky AM, et al. Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: Results from the National Comorbidity Survey Replication Adolescent Supplement. JAMA Psychiatry. 2013;70(3):300-310. https://doi.org/10.1001/2013.jamapsychiatry.55 

Office of the Surgeon General. (2021). Protecting Youth Mental Health: The US Surgeon General’s Advisory [Internet]. surgeon-general-youth-mental-health-advisory.pdf (hhs.gov)

Ward D. Office Practicum, Pediatric Success Series: The Concerning Trend in Behavioral Health Emergency Room Visits for Children and Adolescents. https://www.officepracticum.com/blog/the-concerning-trend-in-mental-health-emergency-room-visits-for-children-and-adolescents/ 

Yard E, Radhakrishnan L, Ballesteros MF, Sheppard M, Gates A, Stein Z, et al. Emergency Department visits for suspected suicide attempts among persons aged 12-25 years before and during the COVID-19 pandemic- United States, January 2019-May 2021. Morbidity and Mortality Weekly Report, 70(24), 888. https://www.cdc.gov/mmwr/volumes/72/wr/mm7226a2.htm?s_cid=mm7226a2_w 

Test your knowledge with the optional 5-question multiple choice quiz below. (Note: If you wish to receive a certificate of completion for this MC3 Clinical Pearl, you must receive a passing score of 80%.)

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Suicidal and Non-Suicidal Self-Injurious Behavior Quiz

1. Which of the following is most accurate about suicide risk screening in pediatric primary care practices? (Select one.)

2. You are conducting a well child visit with an adolescent and notice a Patient Health Questionnaire (PHQ-9) score of 18 with a positive response to question 9 on the PHQ-9. Which of the following is the next best course of action in the care of this patient? (Select one.)

3. Which of the following is most accurate about talking to caregivers after a teen discloses non-suicidal self-harm (NSSI)? (Select one.)

4. Which of the following has no evidence of benefit in managing suicide risk in youth? (Select one.)

5. Which of the following are important components of the safety planning intervention? (Select three of the options below.)

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