Available Knowledge

There is a growing corpus of work devoted to understanding and resolving the issue of

suicidal behaviors among adolescents and teenagers, which is a major public health concern.

Individual, family, societal, and cultural variables all have a role in the development of suicidal

behaviors. The risk factors, protective factors, and successful interventions for this group have all

been the subject of previous research.

Risk Factors

The studies conducted by Abdullayeva (2019), Adam et al. (1996), Miranda-Mendizabal

et al. (2019), Pillai et al. (2008), Nock et al. (2013), Bridge et al. (2006), Klomek et al. (2010),

and Marshal et al. (2011) provide valuable insights into the factors influencing suicidal behavior

among adolescents and young individuals.

Abdullayeva (2019) denoted the effect of dysfunctional family dynamics, parenting

styles, as well as hereditary predisposition on the development of self-injurious behaviours in

adolescents. The study focused on a cohortof adolescents aged 15 to 17 years who exhibited

symptoms of depression and behavioural disorders. The study found that a significant proportion

(53%) exhibited a hereditary predisposition to alcoholism from their parents and mental

disorders from their relatives. This predisposition resulted in familial conflicts, non-adherence to

moral and social norms, and suboptimal financial and residential circumstances. The study also

determined that a significant proportion of adolescents (70%) were found to reside in

dysfunctional families characterized by destructive relationships. Adam et al. (1996) focused on

attachment patterns along with their relationship with a history of suicidal behaviour. The

researchers identified preoccupied together with unresolved-disorganized attachments patterns in

the case group, whereas the comparison group demonstrated dismissing attachment patterns.

Miranda-Mendizabal et al. (2019) explored gender-specific risk factors for suicidal behaviors.
The study found females to have a higher likelihood of attempting suicide, while males had a

higher likelihood of suicidal death. The study highlighted risk factors particular to each gender,

including mental disorders, exposure to violence, and interpersonal difficulties.

Pillai et al. (2008) focused on the influence of structural determinants of gender

disadvantage, violence, and poor mental health on suicidal behaviour among young individuals

(16-24 years). The study determined the occurrence of suicidal behavior to be linked to both

violence and psychological distress, and gender disadvantage exacerbated the vulnerability of

rural women to these factors. Nock et al. (2013), Bridge et al. (2006), Klomek et al. (2010), and

Marshal et al. (2011) highlighted additional risk factors for suicidal behavior among adolescents,

such as mental disorders, peer influence, trauma or abuse history, social isolation, bullying,

academic problems, and demographic characteristics.

Protective Factors

It is important to find protective variables that may assist lower the risk of suicide among

teenagers and adolescents, just as it is important to recognize risk factors for suicidal behaviors.

Lower levels of suicidal thoughts and conduct have been consistently linked to social support

from family, friends, and significant others (King & Vidourek, 2012). Positive coping methods,

problem-solving abilities, and resilience have been proven to mitigate the impacts of stress and

safeguard against suicidal thoughts and behaviors (Kashani et al., 2012). The risk of suicidal

behaviors among teenagers and adolescents may be significantly reduced by communal and

social variables in addition to individual-level protective factors like resilience (Sher, 2019). By

acting as a protective factor, resilience lessens the likelihood of suicide thoughts and actions by

equipping people with the resources they need to deal with adversity, grow their coping

mechanisms, find meaning and purpose in life, connect with others, and solve problems and seek
assistance (Sher, 2019). These traits help people feel more emotionally stable, provide them the

resources they need to cope with adversity, and decrease the likelihood that they may consider or

attempt suicide (Sher, 2019). Furthermore, lower rates of suicide have been linked to improved

access to mental health treatment, supportive educational settings, and strong social networks

(Wyman et al., 2010).

The Role of Mental Health Professionals and Outpatient Settings

In order to recognize, evaluate, and treat suicidal behaviors in teenagers and adolescents,

outpatient mental health settings are essential. In these types of facilities, mental health providers

have the opportunity to use research-backed treatments and personalize care for each patient

(Ougrin, 2018). To create a seamless and complete system of treatment for at-risk adolescents,

they may work with other experts, including primary care doctors, educators, schools, and

community groups. There is a growing amount of research on best practices for mental health

professionals dealing with suicidal adolescents, including recommendations for risk assessment,

safety planning, and crisis management (Pisani, Murrie, & Silverman, 2016). To guarantee that

mental health practitioners have the most up-to-date information and skills in suicide prevention,

research has also emphasized the need of continual professional development and training

(Luxton, June, & Comtois, 2013).

Education in Suicide Prevention

A review of multiple research articles supports the notion that many health care practitioners lack

education associated with suicide prevention. Specifically, there is a lack of consistent standards

for training nurses in suicide assessment within institutes for higher education in nursing, leading

to a gap in suicide-specific intervention training (Puntil et al., 2013). Betz et al. (2013)

discovered significant deficiencies in provider training, biased attitudes towards patients with
mental health issues, and doubts regarding the effectiveness of suicide prevention approaches. To

illustrate, a survey conducted with 85 graduate psychiatric nursing program directors revealed

that 87% of the respondents had not considered providing firearm injury prevention training to

their students, despite the fact that a majority of suicides involve firearms (Khubchandani et al.,

2011. The American Psychiatric Nurses Association (APNA) supports the inclusion of lethal

means restriction, a crucial suicide prevention strategy, in nursing curricula, but currently, it is

not a standard practice (Khubchandani et al., 2011).

Nevertheless, a consistent finding in the literature is that training can lead to positive changes in

attitudes and improved detection skills, although the training programs themselves can vary

significantly. For instance, Chan et al. (2009) conducted an 18-hour education intervention with

medical-surgical RNs in Hong Kong, resulting in significant improvements in nurses' attitudes

and competence regarding suicide prevention and the management of patients who have

attempted suicide. Similarly, Jones (2010) provided a 6.5-hour training session to health

professionals, which led to significant increases in confidence and knowledge, with 93% of

participants indicating their intention to apply what they learned in their clinical practice. In a

randomized controlled trial in Taiwan, Tsai et al. (2011) implemented a 90-minute gatekeeper

awareness program in hospitals, leading to improved attitudes and a willingness to apply suicide

training into practice. Taur and colleagues (2012) offered a two-hour training session to

oncology nurses on the use of a suicide screening tool, resulting in nurses feeling more

comfortable assessing and communicating with suicidal clients.

Despite variations in training duration, Palmieri et al. (2008) highlighted the importance

of interview skills for detecting suicidal intent and indirect interrogation in effective training

programs. Gatekeeper training, aimed at recognizing warning signs of suicide, was identified as
particularly beneficial (Palmieri et al., 2008). The literature identifies two different commonly

used Gatekeeper trainings including ASIST (Applied Suicide Intervention Skills Training) and

QPR (Question, Persuade, and Refer). ASIST is a 14-hour education program that offers training

in "suicide first aid" and equips participants with the ability to identify signs of suicide risk and

effectively respond to enhance the individual's safety while connecting them with appropriate

resources (LivingWorks, 2014). The program incorporates simulations to enhance the

development of practical skills LivingWorks (2014). QPR is an online training program that

typically spans 6 to 8 hours and focuses on enhancing knowledge and attitudes regarding suicide

(QPR Institute, 2014). Its primary objectives are to enhance participants' comfort level in

addressing suicide-related concerns, train healthcare providers in conducting triage assessments

for immediate risk, addressing urgent patient safety needs, and determining the most suitable

care setting (QPR Institute, 2014).

The Tennessee Lives Count Project (TLCP) is an excellent example of a successful

implementation of Gatekeeper training. The project aimed to address suicide prevention among

high-risk youth by implementing targeted strategies for adults who interact with them regularly

(Keller et al., 2009). Through a collaborative effort between public and private entities at state

and regional levels, Gatekeeper training was provided to approximately 14,000 professionals,

including nurses, with the goal of enhancing awareness of suicidal risk factors (Keller et al.,

2009). The outcomes of the project demonstrated enhanced knowledge and self-efficacy in

utilizing suicide prevention techniques (Keller et al., 2009). Notably, this initiative marked the

first statewide implementation of a long-term Gatekeeper training program with the objective of

reducing suicide rates among young individuals (Keller et al., 2009).