Review: evidence is lacking about suicide prevention in young people.

Main results Risk factors for suicide include psychopathology, a family history of psychopathology or suicide, adverse life events, abuse and poor socio-economic circumstances. Protective factors include family cohesion and religious belief. Schools based prevention programmes: limited evidence supports training of school staff to recognise students at risk of suicide, and crisis intervention after a suicide to reduce the risk of subsequent suicides in peers. There is insufficient evidence on the effectiveness of schoolbased suicide awareness programmes, peer support programmes, or problem-solving and coping skills development courses. Screening strategies for suicide risk yield many false positives, and youths who screen negative may become high-risk in future, suggesting that frequent repeat screening would be needed. Community-based prevention programmes: evidence is lacking about the effectiveness of crisis helplines for youth at risk of suicide, or for the effectiveness of legislation to restrict firearms. There is evidence that implementing media guidelines to reduce “sensational” reporting of suicides reduces risk of imitation. Health-care-based prevention and treatment interventions: educational training programmes for health professionals increase the chances of the professional asking young people about suicidal ideation, but repeated interventions are required to maintain this activity and encourage appropriate management. Crisis interventions for suicidal adolescents are based on consensus rather than randomised studies, and include reducing access to methods of suicide in the home (firearms and medicines) and “no suicide” contracts. Dialectical behaviour therapy reduces suicide among depressed adolescents and reduces subsequent suicide attempts in adults with a history of attempted suicide. Effectiveness of antidepressants has been extrapolated from adult studies, because there has been little research in adolescents. Antidepressants are now more commonly used in adolescents and may account for the recent fall in suicide rates.