Nervenheilkunde 2017; 36(04): 227-232
DOI: 10.1055/s-0038-1627009
Suizid
Schattauer GmbH

Suizidalität im Kindes- und Jugendalter

Suicidal behavior in children and adolescents
P. L. Plener
1   Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universitätsklinikum Ulm
,
R. C. Groschwitz
1   Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universitätsklinikum Ulm
,
N. D. Kapusta
2   Klinik für Psychoanalyse und Psychotherapie, Medizinische Universität Wien
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Publikationsverlauf

eingegangen am: 04. Oktober 2016

angenommen am: 20. Oktober 2016

Publikationsdatum:
20. Januar 2018 (online)

Zusammenfassung

Suizidales Verhalten hat einen ersten Häufigkeitsgipfel in der Adoleszenz. Trotz der im Vergleich zum Erwachsenenalter geringeren Suizidprävalenz, werden Suizidgedanken von etwa einem Drittel und Suizidversuche von 6–9% der Jugendlichen in Deutschland beschrieben. Risikofaktoren mit besonderer Relevanz für das Jugendalter umfassen Mobbing, psychische Erkrankungen, familiäre Konflikte, Konflikte in romantischen Liebesbeziehungen und nicht suizidales Selbstverletzendes Verhalten. In der Psychotherapie ist in dieser Altersgruppe vor allem der Einbezug des familiären Umfelds essenziell, während keine Evidenz für eine spezifische psychopharmakologische Behandlung suizidalen Verhaltens existiert. Die Wirksamkeit suizidpräventiver Maßnahmen im Jugendalter konnte auf verschiedenen Ebenen demonstriert werden.

Summary

Suicidal behavior first peaks in adolescence. Although suicide rate are relatively low compared to rates in adults, a history of suicidal ideation is reported from about a third- and suicide attempts from 6–9% of adolescents in Germany. Risk factors with special relevance in adolescence include bullying, psychiatric disorders, conflicts in the family, conflicts in romantic relationships and Non suicidal Self-injury. In psychotherapy, integrating the family is essential, whereas no evidence for a specific psychopharmacological treatment of suicidal behavior exists. The efficacy of suicide prevention measures in adolescence on different levels has been demonstrated.

 
  • Literatur

  • 1 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Washington: American Psychiatric Association; 2013
  • 2 Andover MS, Morris BW, Wren A, Bruzzese ME. The co-occurrence of non-suicidal self-injury and attempted suicide among adolescents: distinguishing risk factors and psychosocial correlates. Child Adolesc Psychiatry Ment Health 2012; 06: 11.
  • 3 Baus N. et al. Personality organization in borderline patients with a history of suicide attempts. Psychiatry Res 2014; 218: 129-133.
  • 4 Bearman PS, Moody J. Suicide and friendships among American adolescents. Am J Public Health 2004; 94: 89-95.
  • 5 Bennett K. et al. A youth suicide prevention plan for Canada: a systematic review of reviews. Can J Psychiatry 2015; 60: 245-257.
  • 6 Bowes L, Cranegie R, Pearson R, Mars B, Biddle L, Maughan B, Lewis G, Fernyhough C, Heron J. Risk of depression and self-harm in teenagers identifying with goth subculture: a longitudinal cohort study. Lancet Psychiatry 2015; 02: 793-800.
  • 7 Brent DA, Mann JJ. Familial pathways to suicidal behavior-understanding and preventing suicide among adolescents. N Engl J Med 2006; 355: 2719-2721.
  • 8 Brent DA, McMakin DL, Kennard BD, Goldstein TR, Mayes TL, Douaihy AB. Protecting adolescents from self-harm: a critical review of intervention studies. J Am Acad Child Adolesc Psychiatry 2013; 52: 1260-1271.
  • 9 Brent DA, Melhem NM, Oquendo M, Burke A, Birmaher B, Stanley B, Biermesser C, Keilp J, Kolko D, Ellis S, Porta G, Zelaszny J, Iyengar S, Mann JJ. Familial pathways to early-onset suicide attempt: a 5.6-year prospective study. JAMA Psychiatry 2015; 72: 160-168.
  • 10 Brent D. et al. Predictors of spontaneous and systematically assessed suicidal adverse events in the treatment of SSRI-resistant depression in adolescents (TORDIA) study. Am J Psychiatry 2009; 166: 418-426.
  • 11 Brunstein AKlomek. et al. Association between victimization by bullying and direct self injurious behavior among adolescence in Europe: a tencountry study. Eur Child Adolesc Psychiatry. 2016 Epub ahead of print. Doi: 10.1007/ s00787-016-0840-7
  • 12 Bürgin D. Trauer bei Kindern und Erwachsenen. Zeitschrift für Psychoanalytische Theorie und Praxis 1989; 04: 55-78.
  • 13 Bürgin D. Kinder und der Tod. In: Battegay R. U. Rauchfleisch (Hrsg.). Das Kind in seiner Welt. Göttingen: Vandenhoeck & Ruprecht; 1991: 82-95.
  • 14 Carroll R, Thomas KH, Bramley K, Williams S, Grifin L, Potokar J, Gunnell D. Self-cutting and risk of subsequent suicide. J Affect Dis 2016; 192: 8-10.
  • 15 Chambers RA, Taylor JR, Potenza MN. Developmental neurocircuitry of motivation in adolescence: a critical period of addiction vulnerability. Am J Psychiatry 2003; 160: 1041-1052.
  • 16 Cuddy-Casey M, Orvaschel H. Children’s understanding of death in relation to child suicidality and homicidality. Clin Psychol Rev 1997; 17: 33-45.
  • 17 Deutsche Gesellschaft für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie. Behandlung von depressiven Störungen bei Kindern und Jugendlichen. 2013 www.awmf.org/uploads/ tx_szleitlinien/028–043l_S3_Depressive_St%C3%B6rungen_bei_Kindern_Jugendlichen_2013–07.pdf
  • 18 Deutsche Gesellschaft für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie. Suizidalität im Kindes- und Jugendalter. 2016 www.awmf.org/uploads/tx_szleitlinien/ 028–031l_S2k_Suizidalitaet_KiJu_2016–07_01.pdf
  • 19 Donath C, Graessel E, Baier D, Bleich S, Hillemacher T. Is parenting style a predictor of suicide attempts in a representative sample of adolescents?. BMC Pediat 2014; 14: 113.
  • 20 Du Roscoät E, Legleye S, Guignard R, Husky M, Beck F. Risk factors for suicide attempts and hospitalizations in a sample of 36,542 French adolescents. J Affect Dis 2016; 190: 517-521.
  • 21 Gibbons RD, Brown CH, Hur K, Marcus SM, Bhaumik DK, Erkens JA, Herings RM, Mann JJ. Early evidence on the effects of regulators’ suicidality warnings on SSRI prescriptions and suicide in children and adolescents. Am J Psychiatry 2007; 164: 1356-1363.
  • 22 Glenn CR, Franklin JC, Nock MK. Evidence-Based Psychological Treatments for Self-Injurious Thoughts and Behaviors in Youth. J Clin Child Adoles Psychol 2015; 44: 1-29.
  • 23 Groschwitz RC, Kaess M, Fischer G, Ameis N, Schulze UM, Brunner R, Koelch M, Plener PL. The association of non-suicidal self-injury and suicidal behavior according to DSM-5 in adolescent psychiatric inpatients. Psychiatry Res 2015; 228: 454-461.
  • 24 Habermas T, Rosemeier HP. Kognitive Entwicklung und Todesbegriff. In: Seiffge-Krenke I. (Hrsg.) Krankheitsverarbeitung bei Kindern und Jugendlichen. Berlin: Springer; 1990: 263-279.
  • 25 Hamza CA, Stewart SL, Willoughby T. Examining the link between nonsuicidal self-injury and suicidal behavior: a review of the literature and an integrated model. Clin Psychol Rev 2012; 32: 482-495.
  • 26 Hawton K, Bergen H, Cooper J. et al. Suicide following self-harm: findings from the Multicentre Study of self-harm in England, 2000–2012. J Affect Disord 2015; 175: 147-151.
  • 27 Holt MK, Vivolo-Kantor AM, Polanin JR, Holland KM, DeGue S, Matjasko JL, Wolfe M, Reid G. Bullying and suicidal ideation and behaviors: a metaanalysis. Pediatrics 2015; 135: e496-509.
  • 28 Jantzer V, Haffner J, Parzer P, Resch F, Kaess M. Does parental monitoring moderate the relationship between bullying and adolescent nonsuicidal self-injury and suicidal behavior? A communitybased self-report study of adolescents in Germany. BMC Public Health 2015; 15: 583.
  • 29 Joiner T. Why people die by suicide. Harvard: University Press; 2015
  • 30 Kaess M, Parzer P, Haffner J, Steen R, Roos J, Klett M, Brunner R, Resch F. Explaining gender differences in non-fatal suicidal behavior among adolescents: a population-based study. BMC Public Health 2011; 11: 597.
  • 31 Kapusta ND. Non-suicidal Self-injury and suicide risk assessment, quo vaids DSM-V?. Suicidology Online 2012; 03: 1-3.
  • 32 Kapusta ND, Fegert JM, Haring C, Plener PL. Psychotherapeutische Interventionen bei suizidalen Jugendlichen. Psychotherapeut 2014; 59: 16-23.
  • 33 Kokkevi A, Rotsika V, Arapaki A, Richardson C. Adolescents’ self-reported suicide attempts, selfharm thoughts and their correlates across 17 European countries. J Child Psychol Psychiatry 2012; 53: 381-389.
  • 34 Lereya ST, Copeland WE, Costello EJ, Wolke D. Adult mental health consequences of peer bullying and maltreatment in childhood: two cohorts in two countries. Lancet Psychiatry 2015; 02: 524-531.
  • 35 Lereya ST, Winsper C, Heron J, Lewis G, Gunnell D, Fisher HL, Wolke D. Being bullied during childhood and the prospective pathways to self-harm in late adolescence. J Am Acad Child Adolesc Psychiatry 2013; 52: 608-618.
  • 36 Mayr M, Kapusta ND, Plener PL, Pollak E, Schulze U, Freyberger HJ, Fegert JM. Transitionspsychiatrie der Adoleszenz und des jungen Erwachsenenalters. Zeitschrift für Psychiatrie, Psychologie und Psychotherapie 2015; 63: 155-165.
  • 37 McLoughlin AB, Gould MS, Malone KM. Global trends in teenage suicide: 2003–2014. QJ Med 2015; 108: 765-780.
  • 38 Miller M, Pate V, Swanson SA, Azrael D, White M, Stürmer T. Antidepressant class, age, and the risk of deliberate self-harm: a propensity score matched cohort study of SSRI and SNRI users in the US. CNS Drugs 2014; 28: 79-88.
  • 39 Nemeroff CB, Kalali A, Keller MB, Charney DS, Lenderts SE, Cascade EF, Stephenson H, Schatzberg AF. Impact of publicity concerning pediatric suicidality data on physician practice patterns in the United States. Arch Gen Psychiatry 2007; 64: 466-472.
  • 40 Nock MK, Green JG, Hwang I, McLaughlin KA, Sampson NA, Zaslavsky AM, Kessler RC. Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: results from the National Comorbidity Survey Replication Adolescent Supplement. JAMA Psychiatry 2013; 70: 300-310.
  • 41 Ougrin D, Tranah T, Stahl D, Moran P, Asarnow JR. Therapeutic interventions for suicide attempts and self-harm in adolescents: systematic review and meta-analysis. J Am Acad Child Adolesc Psychiatry 2015; 54: 97-107.
  • 42 Oxford Centre for Evidence-based Medicine. Levels of evidence (March 2009). 2009 www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/
  • 43 Paus T, Keshavan M, Giedd JN. Why do many psychiatric disorders emerge during adolescence?. Nature Reviews Neuroscience 2008; 09: 947-957.
  • 44 Plener PL. Suizidales Verhalten und nichtsuizidale Selbstverletzung. Heidelberg: Springer; 2015: 117.
  • 45 Plener PL, Fegert JM, Kölch MG. Psychopharmakologische Behandlung von Depressionen im Kindes- und Jugendalter – Entwicklungen und Standards seit der “Black Box” Warnung. Zeitschrift für Kinderund Jugendpsychiatrie und Psychotherapie 2012; 40: 365-371.
  • 46 Plener PL, Libal G, Keller F, Fegert JM, Muehlenkamp JJ. An international comparison of adolescent non-suicidal self-injury (NSSI) and suicide attempts: Germany and the USA. Psychol Med 2009; 39: 1549-1558.
  • 47 Séguin M, Beauchamp G, Robert M, DiMambro M, Turecki G. Developmental model of suicide trajectories. Br J Psychiatry 2014; 205: 120-126.
  • 48 Sharma T, Guski LS, Freund N, Gøtzsche PC. Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports. BMJ 2016; 352: i65.
  • 49 Sinyor M, Schaffer A, Streiner DL. Characterizing suicide in Toronto: an observational study and cluster analysis. Can J Psychiatry 2014; 59: 26-33.
  • 50 Statistisches Bundesamt. Anzahl der Suizide nach Altersgruppen. 2014 Unter: https://www.destatis.de/DE/ZahlenFakten/GesellschaftStaat/Gesundheit/Todesursachen/Tabellen/Sterbefaelle_Suizid_ErwachseneKinder.html
  • 51 Umetsu R, Abe J, Ueda N, Kato Y, Matsui T, Nakayama Y, Kinosada Y, Nakamura M. Association between selective serotonin reuptake inhibitor therapy and suicidality: analysis of U.S. Food and Drug Administration adverse event reporting system data. Biol Pharm Bull 2015; 38: 1689-1699.
  • 52 Värnik A. et al. Gender issues in suicide rates, trends and methods among youths aged 15–24 in 15 European countries. J Affect Dis 2009; 113: 216-226.
  • 53 Wasserman D. et al. School-based suicide prevention programmes: the SEYLE cluster-randomised, controlled trial. Lancet 2015; 385: 1536-1544.
  • 54 Wichstrøm L. Predictors of non-suicidal self-injury versus attempted suicide: similar or different?. Arch Suicide Res 2009; 13: 105-122.
  • 55 Wong MW, Brown KJ, Zucker RA. Sleep problems, suicidal ideation, and self-harm behaviors in adolescence. J Psychiatr Res 2011; 45: 505-511.
  • 56 Young R, Sproeber N, Groschwitz RC, Preiss M, Plener PL. Why alternative teenagers self-harm: exploring the link between non-suicidal self-injury, attempted suicide and adolescent identity. BMC Psychiatry 2014; 14: 137.
  • 57 Zalsman G. et al. Suicide prevention strategies revisited: 10-year systematic review. Lancet Psychiatry 2016; 03: 646-659.
  • 58 Nock MK. et al. Cross-National Prevalence and Risk-Factors of Suicidal Ideation, Plans, and Attempts. Br J Psychiatry 2008; 192: 98-105.