Emergency services are seeing more and more adolescents and young adults arriving after self-harm or a suicide attempt. Suicide is among the leading causes of death in this age group, and self-harm, even without the intention of dying, remains one of the main causes of suffering and hospitalization.
For the High Authority of Health, a suicide attempt in a teenager is never a simple “crisis” episode to be trivialized. Around a third of suicides repeat suicide within a year, and 1 to 2% die by suicide within this period, which pushes teams to fundamentally rethink the
adolescent suicide and self-harm prevention. A new approach is emerging.
Graduated care to adjust assistance to the level of risk
In the United States, a team from UCLA and Kaiser Permanente followed 301 young people aged 12 to 24, all at high risk of suicide orself-harm. Two care organizations were compared: a global Zero Suicide program (reinforced screening, safety plans, continuous improvement), and this same base supplemented by a “stratified graduated care” model inspired by cognitive-behavioral therapies and behavioral dialectics. Developed by psychology researcher Marsha M. Linehan, dialectical behavior therapy (DBT) combines cognitive-behavioral psychotherapy techniques with relaxation, distress tolerance and open-minded exercises.
a skills-based treatment that can help patients regulate their emotions more effectively, improve their relationships with others, build tolerance for difficulties, and be more aware of their thoughts, feelings, and behaviors.
Young people at lower risk received follow-up from a case manager, regular monitoring and digital tools, while those most at risk were referred to DBT skills groups and individual therapies. After 12 months, this graduated model resulted in an approximately 54% reduction in self-harm episodes compared to the standard program, a sharper reduction in depression and greater satisfaction with care. “Our results suggest the potential for an approach that combines health system quality improvement initiatives with stratified, tiered management, providing more intensive treatment services as assessed risk levels increase. This approach can result in a significant reduction in self-harming behaviors and depression, with a high level of patient satisfaction” said Joan Asarnow, professor of psychiatry and biobehavioral sciences at UCLA.
The researchers emphasize that the significant reduction in self-harm is an important clinical outcome, as it is associated with an increased risk of suicide attempts and subsequent death, as well as significant morbidity.
Social networks: spotting weak signals of distress
At King’s College London, the 3S-YP study followed 20 young people aged 13 to 25 with self-harming behavior, linking their episodes of self-harm to their images published on Instagram, Facebook or X for six months. For Professor Rina Dutta, professor of psychiatry at IoPPN at King’s College London, “Self-harm among young people is very often a sign of distress. These are people who need support not only from healthcare professionals, but also from family and friends“But the researchers found that they posted very little content on the day of the self-harm, without explicit images or glorification of the gesture, but with signs of digital withdrawal and masking of distress. These observations could reflect young people’s fears of being stigmatized or of posting content likely to upset others, but also increased moderation on the part of social media platforms.
“Although the young people in this study had resorted to self-harm, their posts showed no obvious signs of deterioration in their mental well-being. Rather, they reflected a diversity of content, with subtle changes and signs of temporary digital retreat on the day of the event. This highlights the need to develop risk detection approaches that, beyond explicit content, take into account more indirect indicators of distress.“, explained Dr. Amanda Bye, translational researcher and first author of the study.
“Although there are many worrying examples of the negative impact of social media on young people, our study found that – for this group in particular – it also offers a way to express difficult emotions and encourage others facing similar difficulties to seek help” says Rina Dutta.
Emergencies, hospitalization, follow-up: organize a continuous pathway
In France, the High Authority of Health recommends that after any suicide attempt, each adolescent receives a somatic, psychological and social evaluation, ideally in the emergency room. Hospitalization should be preferred in cases of strong intentionality, unstabilized psychiatric pathology, a harmful environment or the impossibility of quickly organizing structured follow-up. A “referent” professional is designated to coordinate further care.
By combining this organization of the pathway with graduated care based on the real level of risk and increased attention to weak signals identifiable in daily life and online, the teams are gradually drawing up an integrated prevention model for 12-24 year olds. A model where early detection, adjustment of the intensity of care and proactive monitoring seek to break the chain that leads from repeated self-harm to suicide attempts.