By Carolyn Crist
Although experts supervising new pediatricians and teaching trainee doctors agree that preventing child and teen suicide is important, most also say current training isn't adequate, according to a new U.S. study.
The training isn't always mandatory, for instance, and it isn't standardized, the study authors write in a paper in the Journal of Adolescent Health, online May 22.
"Pediatric providers play a crucial role in detecting suicide risk and appropriately referring those in need," said senior study author Rebecca Bernert, director of the Suicide Prevention Research Laboratory at the Stanford University School of Medicine in California.
Suicide is the second leading cause of death among youth, who attempt suicide at disproportional rates compared to other age groups, Bernert added. The Joint Commission and the American Academy of Pediatrics recommend consistent screening, but little is known about the quality of training.
"Despite significant advancements in suicide risk assessment, training practices appear to lack uniformity across diverse medical fields, including first-line providers in a position to significantly impact screening for suicidal behaviors," Bernert told Reuters Health by email.
Bernert and colleagues sent a survey to the directors of all 204 U.S. pediatric residency programs and to 494 pediatric chief residents in May 2017 through the Association of Pediatric Program Directors listserv. The survey asked about the importance of suicide prevention training and for details about training in each of the programs. The research team received responses from 95 program directors and 210 chief residents.
Overall, 82% of respondents rated suicide prevention training during a residency program as "very" or "extremely" important. At the same time, only about 18% of program directors and 10% of chief residents said their programs had adequate preparation relative to the need. The average training lasted about three hours, and the top priorities included interviewing adolescents about risk, identifying risk factors and locating community resources.
"Putting time and space between the thought and the method for a suicide attempt is life-saving," Bernert said. "We can't prevent death if we do not know a person is at risk."
About half of the survey participants said their program had formal training for residents, and most said their training was mandatory and most often occurred during trainees' adolescent medicine rotation. The majority of programs taught doctors to use a standardized screening instrument, but they used a mix of guidelines and policies.
In addition, respondents cited training barriers such as limited time, lack of training resources and the need for additional expert faculty to guide the training. During meetings with patients, they said the top barriers to consistent suicide risk assessment included lack of time during appointments, lack of community resources and a lack of clarity about best practices.
"The suicide rate has been rising nationally in almost all demographic groups, specifically among young people, and it is indeed a public health crisis," said Michael Schoenbaum of the National Institute of Mental Health in Bethesda, Maryland.
Pediatricians have expressed concerns about what to do after screening, especially in rural areas where they may be the only doctor or have few mental health professionals to refer patients, added Schoenbaum, who wasn't involved in the survey.
New initiatives should build these relationships in the community so doctors know where to turn and how to quickly help a patient book an appointment, he said.
"Few communities have a resource like that, and we should commit to helping patients be seen in 24 hours in these circumstances," Schoenbaum said by email. "This shouldn't be a burden borne by pediatricians alone, so let's figure out how to organize ourselves to do this."
J Adolesc Health 2019.
(c) Copyright Thomson Reuters 2019. Click For Restrictions - https://agency.reuters.com/en/copyright.html