Childhood adversity and mental health admission patterns prior to young person suicide (CHASE): a case-control 36 year linked hospital data study, Scotland UK 1981-2017.

BACKGROUND: Childhood adversity is associated with increased later mental health problems and suicidal behaviour. Opportunities for earlier healthcare identification and intervention are needed. AIM: To determine associations between hospital admissions for childhood adversity and mental health in children who later die by suicide. METHOD: Population-based longitudinal case-control study. Scottish in-patient general and psychiatric records were summarised for individuals born 1981 or later who died by suicide between 1991 and 2017 (cases), and matched controls (1:10), for childhood adversity and mental health (broadly defined as psychiatric diagnoses and general hospital admissions for self-harm and substance use). RESULTS: Records were extracted for 2477 'cases' and 24 777 'controls'; 2106 cases (85%) and 13 589 controls (55%) had lifespan hospitalisations. Mean age at death was 23.7; 75.9% were male. Maltreatment or violence-related childhood adversity codes were recorded for 7.6% cases aged 10-17 (160/2106) versus 2.7% controls (371/13 589), odds ratio = 2.9 (95% CI, 2.4-3.6); mental health-related admissions were recorded for 21.7% cases (458/2106), versus 4.1% controls (560/13 589), odds ratio = 6.5 (95% CI, 5.7-7.4); 80% of mental health admissions were in general hospitals. Using conditional logistic models, we found a dose-response effect of mental health admissions <18y, with highest adjusted odds ratio (aOR) for three or more mental health admissions: aORmale = 8.17 (95% CI, 5.02-13.29), aORfemale = 15.08 (95% CI, 8.07-28.17). We estimated that each type of childhood adversity multiplied odds of suicide by aORmale = 1.90 (95% CI, 1.64-2.21), aORfemale = 2.65 (95% CI, 1.94-3.62), and each mental health admission by aORmale = 2.06 (95% CI, 1.81-2.34), aORfemale = 1.78 (95% CI, 1.50-2.10). CONCLUSIONS: Our lifespan study found that experiencing childhood adversity (primarily maltreatment or violence-related admissions) or mental health admissions increased odds of young person suicide, with highest odds for those experiencing both. Healthcare practitioners should identify and flag potential 'at-risk' adolescents to prevent future suicidal acts, especially those in general hospitals.

Suicide prevention: Introducing the Lothian Safekeeping Plan© for parents as a clinical innovation for use alongside safety plans for children and young people.

TOPIC: Internationally, preventing suicide in children and young people is a priority and there are a range of preventative approaches available for health professionals to use, including brief interventions. Safety planning is one such brief intervention. Safety plans have long been recommended for use with young people who are suicidal but, these were initially developed for adults. A recent scoping review revealed safety plans need to be tailored to children and young people. This review also identified an important practice gap, that parents also require plans supporting them to keep their child safe. PURPOSE: This paper highlights how a Scottish clinical child and adolescent mental health setting in the UK's National Health Service developed and implemented evidence-based safety plans for suicidality-the Lothian Safety Plan for young people and the Lothian Safekeeping Plan for parents. This paper outlines both plans and gives recommendations for their use by healthcare professionals. The parental Lothian Safekeeping Plan is discussed in more depth as this is a novel intervention. CONCLUSION: The Lothian Safekeeping Plan is a clinically led evidence-based practice innovation. It is a specific suicide prevention plan for use by parents as an additional, complementary, and enhanced resource to the Lothian Safety Plan for young people. It is recommended that healthcare professionals also use a parental safety plan when supporting young people presenting with suicidal crisis. Further research is needed to evaluate the impact of these plans.

Suicide prevention: What does the evidence show for the effectiveness of safety planning for children and young people? - A systematic scoping review.

WHAT IS KNOWN ON THE SUBJECT?: Suicide prevention is an international healthcare priority. There is an urgent need to use approaches that are helpful and follow research evidence. Safety planning is now widely used in suicide prevention; however, it was developed for use with adults, and little is known about its effectiveness for children/young people. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This systematic scoping review brings together all research evidence since 2008 that reported how effective safety planning is for children/young people. Findings highlight that when healthcare professionals help children/young people who are suicidal, they need to ensure that the safety plan is completed collaboratively with healthcare professionals and children/young people and that it is appropriate for their age and development. There is also need for healthcare professionals to better recognize and respond to the needs of parents/carers who are caring for a child/young person with suicidal ideations/behaviours. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is some research indicating that safety planning is effective for use with children/young people, but such evidence has primarily been obtained from females and there is need for more evidence from male study populations. Further research on its use is needed for certain groups of children/young people including those who are care experienced, or identify as lesbian, gay, bisexual and transgender. This review highlighted that healthcare professionals need specific training before they deliver safety planning for children/young people. It was identified that parents/carers have additional needs and should be involved in safety planning. An additional resource specifically for parents/carers should be developed. ABSTRACT: INTRODUCTION: Suicide is a leading cause of death for children and young people and its prevention is a global priority. Many Mental Health Services employ safety planning as a brief intervention. There is some evidence of safety planning effectiveness for adults, but little is known about its effectiveness with young people. AIM: To synthesize research reporting safety planning effectiveness for children/young people with suicidal ideation and identify good practice recommendations. INCLUSION CRITERIA: The review relates to safety planning around suicide prevention for children/young people aged less than 18 years, even if it was within a wider intervention. The review was inclusive of all clinical areas (including mental health, primary care, etc), any geographical location or social economic status and inclusivity around the method of delivery. METHODS: A systematic scoping review of literature reporting effectiveness data for the use of safety planning with children/young people with suicidal ideation. The systematic scoping review protocol (pre-registered with Open Science Framework) followed Joanna Briggs Institute conduct guidance and PRISMA-ScR checklist. DATA ANALYSIS AND PRESENTATION: Fifteen studies were reported during 2008-2021. Overall, there is promising, but limited, evidence of effectiveness for safety planning for children/young people but with complete evidence gaps for some demographic sub-groups. Evidence determined that healthcare professionals should deliver a safety planning intervention that is completed collaboratively, developmentally appropriate, and recognizes parental/carer involvement. DISCUSSION AND IMPLICATIONS FOR PRACTICE: Further research is needed but current evidence suggests safety planning should be a routine part of care packages for children/young people with suicidal ideation proportionate to their needs. Developing/implementing these plans needs bespoke health professional training and additional support and resources for parents/carers should be developed.