Development of Practice Principles for the Management of Ongoing Suicidal Ideation in Young People Diagnosed with Major Depressive Disorder (MDD)

Presentation First Author: 
Simon Rice

Introduction: Youth suicide remains a significant public health issue and is a leading cause of death amongst young people aged 15-25yrs. Although suicidal ideation is a common phenomenon amongst those diagnosed with moderate-severe MDD, the consequences of acting upon suicidal thoughts can be grave and devastating. As such, carefully planned suicide-specific interventions are crucial for young people experiencing severe depressive symptomology. Although comprehensive guidelines exist for the management of acute suicidality (e.g., the presence of a suicidal plan and intent to enact plan), unfortunately clinicians remain without clear guidance for the ongoing management of sub-acute suicidal ideation in young people. It is essential that this guidance is developed within a youth specific framework given the relatively high levels of impulsivity and risk-taking behaviours in this age group. To date very few high quality intervention-based suicide prevention clinical trials have been undertaken with this population, and there is insufficient data to determine the active ingredients of suicide-specific interventions for young people experiencing ongoing suicide risk. Objectives: In the absence of higher levels of evidence, analysis and documentation of expert consensus is vital to the initial development and refinement of best practice guidelines. To this end, the present study gathered expert consensus data on the management of ongoing suicidal ideation in young people. Methods: Two 90-minute focus group interviews were undertaken with a multidisciplinary, outpatient youth mental health clinic specialising in the management of moderate-severe MDD (N=12 , mean years experience 9.42, SD = 8.47). The Youth Mood Clinic uses a time-limited cognitive behavioural case management model with integrated psychiatry review and crisis support. Responses to the semi-structured interview schedule were audio recorded and transcribed verbatim. Key themes were identified through thematic analysis and classified. Results: Thirteen key practice principles emerged from the data including recommendations related to the treating team (consultation and supervision), engagement (therapeutic alliance), assessment (historical and current risk, protective factors), intervention (crisis planning, restricting access to means, involvement of caregivers, network of care, understanding the nature of suicidal thinking, instilling hope, development of coping skills, consistency of care) and management of acute risk (crisis support). Conclusion: The above practice principles identify essential aspects of therapy and case management for young people experiencing ongoing suicidal ideation in the context of MDD. Implications for clinical care and treatment planning are highlighted. Findings are discussed within the context of the current evidence base for management of ongoing suicidal ideation in young people, and a future research agenda and dissemination of guidelines outlined.

Conference Name: 
Presentation Date: 
November, 2013
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