Evaluation of suicide risk in adolescents.

Self-destructive behavior in the adolescent is a continuum that ranges from drug intoxications to gestures of low lethality to suicide attempts with high lethality of intent. Such behavior should be treated as a signal of long-term stress and strife. A "Psychological biopsy" is outlined for evaluation of the severity and type of perturbation. This focuses on 9 areas of inquiry: the circumstantial lethality of the event; prior self-destructive behavior; depression; hostility; stress; reaction of the parent or parent surrogate; loss of communication; lack of resources; and extremes of parental expectations and control. Adolescents under severe familial and socioeconomic stress, and with a history of acting-out behavior, often respond well to transfer to a more favorable home situation. In cases where there is no apparent familial perturbation, the physician should be alert to the possibility of severe psychiatric disorder. In either case, initial definition of the problem opens the way to a plan for management and support.