Prevalence and treatment effects of suicidal ideation and self-injurious behavior in children and adolescents in outpatient psychotherapy: A multicenter assessment

BACKGROUND: Suicidal ideation and self-injurious behaviors (SISIB) in children and adolescents are a major concern in clinical practice. Yet, little is known about the prevalence rates of SISIB in outpatient clinics and its response to routine psychotherapy. Therefore, the present study aims to assess the prevalence of SISIB and the changes in SISIB in a heterogeneous clinical outpatient sample of children and adolescents undergoing cognitive behavioral therapy in Germany. METHODS: The sample consists of N = 5730 child and adolescent outpatients, 54.05% female, mean age = 12.16 years (SD = 3.51). As metrics of SISIB, two items (Item 18 on self-injurious behavior and Item 91 on suicidal ideation) of the Youth Self Report (YSR/11-18R) and the Child Behavior Checklist (CBCL/6-18R) as caregiver report were used. RESULTS: Pretreatment, suicidal ideation was reported by 33.45% of patients and 15.39% of caregivers. Self-injurious behavior was reported pretreatment by 35.35% of patients and 20.16% of caregivers. Posttreatment, suicidal ideation was reported by 11.32% of patients and 5.25% of caregivers. Self-injurious behavior was reported posttreatment by 19.00% of patients and 9.43% of caregivers. CONCLUSION: SISIB are very common in children and adolescents in outpatient settings. Prevalence rates are higher in self-reports than in caregiver reports, indicating the importance of assessing SISIB in children and adolescents themselves. After routine-care psychotherapy, a substantial proportion of patients report an amelioration of SISIB. These results indicate the importance of monitoring SISIB during treatment and of therapists being aware of risk assessment techniques and psychotherapy interventions targeting SISIB.