Evaluation of suicide risk among youths in community settings.

Identifying youths in imminent danger of suicide and in need of emergency psychiatric services is a difficult task. Although clinicians have often described the psychiatric profile of youths at risk for suicide, there is little empirical evidence of successful strategies for identifying suicidal risk. Researchers are faced with a number of problems when attempting to validate risk evaluation procedures: Suicide risk profiles vary with age and developmental stage; there appear to be several patterns or subtypes of suicidal patterns; suicidality depends on one's current emotional state; evaluators are likely to be biased in the direction of over-estimating risk and are not likely to have extensive clinical training; imminent danger for suicide is time-limited; and a youth's risk will depend on surrounding environmental stressors and supports. These considerations force researchers to assume a strategic approach in defining levels of suicide risk and imminent danger of suicide. An example of a potential strategy for identifying risk among youths is outlined in this chapter. Although this strategic approach appears useful, researchers continue to be faced with major problems in validating such procedures. Determining the predictive validity of potential suicide screening procedures requires researchers to evaluate and to follow longitudinally a large sample of youths, while deliberately refraining from intervening to help those youths who appear to be in crisis.