Suicidal behaviour in young people accessing mental health care

Abstract

Rates of suicidal behaviour in young people have increased despite increased awareness and investment in suicide prevention. Mental health system reform has led to the development of early intervention mental health services and new clinical cohorts distinct from adults accessing mental health services. The effectiveness of clinical suicide prevention relies on in-depth, contemporaneous understanding of suicidal behaviour in clinical populations. The overall aim of this thesis was to generate new scientific understanding of suicidal behaviour in these new clinical cohorts, which may be applied in clinical services to increase the impact of clinical suicide prevention. Chapter 2 uses systematic review and meta-analyses to assess the predictive performance of key risk factors used to direct clinical suicide prevention. Chapter 3 then considers the application of machine learning to the prediction of suicidal behaviour. Chapter 4 explores the utility of cognition as a potential biomarker of suicidal behaviour in young people. Finally, Chapter 5 uses data-linkage to characterise premature mortality and identify health service use predictors of suicide and accident-related deaths in young people accessing early intervention youth mental health services.

In summary, there are unique social, clinical and cognitive predictors of suicidal behaviour in young people accessing clinical services. The high burden of disease associated with these behaviours suggests that all young people accessing mental health services should receive evidence-based suicide prevention interventions. Further, the high rates of adverse outcomes due to accident and injury, drug and alcohol use and emergency department presentations, suggest that developing strategies and designing interventions to address a broader construct of harm should be considered.