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School psychologists play a vital role in the mental health and well-being of students and are often tasked with establishing the assessment and intervention plans for reducing the severity of mental health difficulties, including suicidal behavior. With suicide the second-leading cause of death for middle and high school students, school psychologists need to be familiar with what their role is in recommending and providing suicide prevention and intervention programs within a multitiered systems of support (MTSS) framework. This chapter provides an overview of the problem of adolescent suicidal behavior (“what to know”), while also providing specific recommendations (“what to do”) for suicide prevention/intervention programs within each tier of the MTSS. Finally, this chapter includes specific guidelines for implementing “suicide postvention” (after a death due to suicide) procedures, in hopes of reducing the likelihood of another death due to suicide.
By
Alan Apter, Professor of Psychiatry, Sackler School of Medicine, University of Tel-Aviv Medical School; Chairman, Dept. of Child and Adolescent Psychiatry, Schneider Children's Medical Center of Israel, 14 Kaplan St. Petah Tikva, Israel 49202 e-mail: eapter@clalit.org.il
This chapter reviews the general situation, pointing out the areas that have the most relevance to adolescent suicidal behavior. There appears to be an intimate relationship between the serotonergic parameters of aggression, anxiety, and suicidal behavior, especially in young people. Based on genetic studies and findings relating serotonin to suicidal behavior, some researchers have suggested that the gene coding for the rate-limiting enzyme in serotonin metabolism, tryptophan hydroxylase (TPH), is a candidate gene for suicidal behavior. Regardless of the etiology of suicidal behavior in young people, suicide attempts are extremely rare before puberty. The influence of hormonal factors on suicidal behavior has not been well studied. There has been a great deal of interest in the relationship between carbohydrate (CHO) metabolism, 5-HT systems and aggression. The development of operational criteria for nosological diagnosis has enabled biological researchers to focus on more clearly defined disorders in their search for biological markers.
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