Objective

The rate of adolescent suicide and suicidal behavior has risen dramatically in the past decade. The title of this article comes from the classic coming-of-age novel by J.D. Salinger, The Catcher in the Rye. Its protagonist, Holden Caulfield, is a precocious adolescent who, in the face of his inability to cope with his own self-destructives urges, imagines himself saving “little kids playing some game in this big field of rye.” He is standing on the edge of a cliff trying to catch “thousands of little kids” before they fall to their demise. This vignette from The Catcher in the Rye provides a useful metaphor for the relationship between mental health professionals and youth at risk for suicide, and suggests more efficient and effective alternative interventions to prevent youth suicide compared to standing by a cliff.

Method

These four alternative approaches are described, namely: (1) leading youth away from the cliff (ie, prevention); (2) going to where youth are (ie, improving access to care); (3) working with others to change the rules in the field (ie, changing the way care is delivered); and (4) putting a fence around the cliff (ie, restriction of access to lethal agents). The evidence to support the utility and cost-effectiveness of each of these approaches is reviewed.

Conclusion

There are extant, empirically supported, cost-effective approaches to the prevention and management of adolescent suicidal behavior that, if implemented widely, are likely to significantly reverse the decade-long rise in adolescent suicide.

中文翻译：

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主临床医生评论：拯救霍顿·考菲尔德：预防儿童和青少年自杀。

客观的

在过去十年中，青少年自杀和自杀行为的发生率急剧上升。本文的标题来自JD Salinger的经典成年小说《麦田里的守望者》。它的主人公霍尔顿·考菲尔德（Holden Caulfield）是一个早熟的青少年，由于他无法应付自己的自我毁灭的冲动，他想象自己拯救了“小孩子在这个黑麦大国玩游戏”。他站在悬崖的边缘，试图抓住“成千上万的小孩”，然后让他们灭亡。这本《麦田守望者》中的小插图 提供了一个有用的比喻来说明精神卫生专业人员与处于自杀危险中的年轻人之间的关系，并提出了比站在悬崖边上更有效的替代干预措施，以防止青年自杀。

方法

描述了这四种替代方法，即：（1）引导青年脱离悬崖（即预防）；（2）前往青年所在的地方（即改善获得保健的机会）；（3）与他人合作改变现场规则（即改变护理的提供方式）；（4）在悬崖周围围栏（即限制接触致死性毒剂）。审查支持每种方法的效用和成本效益的证据。

结论

有现成的，有经验支持的，具有成本效益的方法来预防和管理青少年自杀行为，如果得到广泛实施，很可能会扭转长达十年之久的青少年自杀率上升的趋势。