Non-disclosing youth: a cross sectional study to understand why young people do not disclose suicidal thoughts to their mental health professional

BACKGROUND

Prevalence of suicidal ideation increases rapidly in adolescence, and many choose not to seek help and disclose their ideation. Young people who do disclose suicidal ideation, prefer to do so with peers and family compared to mental health professionals, who are best placed to provide evidence-based treatment. This study aimed to identify key factors associated with young people's decision to, or not to disclose suicidal thoughts to their mental health practitioner.

METHODS

A community-based sample of young Australians (16 - 25 years), who had experienced suicidal ideation and engaged with a mental health professional, completed an online questionnaire (N=513) which assessed demographic characteristics, severity of depression, anxiety, psychological distress, and suicidal ideation, lifetime suicide attempts, exposure to suicide loss, personal suicide stigma, prioritisation of mental health issues, and therapeutic alliance. Logistic regression analyses were used to identify factors associated with disclosure.

RESULTS

Though the full sample had engaged in therapy, 39% had never disclosed suicidal ideation to their clinician. Those who had disclosed were more likely to report greater therapeutic alliance (OR=1.04, 95% CI=1.02-1.06), personal suicide stigma (OR=1.04, 95% CI=1.01-1.06), prioritisation of suicidal ideation (OR=.24, 95% CI=0.14-0.42), and lifetime history of suicide attempt (OR=.32, 95% CI=0.18-0.57). The most common reason for not disclosing was concern that it would not remain confidential.

CONCLUSION

These findings provide new insights into why young people may not seek help by disclosing suicidal ideation, despite having access to a mental health professional, and establish evidence to inform practice decisions and the development of prevention strategies to support young people for suicide.

Respect for Persons in the Psychiatric Treatment of Children and Adolescents

Child and adolescent psychiatry involves simultaneously balancing duties to various vulnerable parties. Balancing autonomy and protection for adolescents is complex; state laws governing these situations often add confusion. Common prescribing patterns in child psychiatry lack robust evidence, and utilization of stimulants, atypical antipsychotics, and polypharmacy has skyrocketed. Significant concerns about distributive justice arise from alarming patterns in psychiatric treatment of vulnerable populations, like those affected by poverty, racism, adverse childhood experiences, and certain legal statuses. Principles of justice and respect for persons support the need for safe, adequate, and appropriate psychiatric treatment, including psychosocial interventions and resources, for all children.

A Social-Identity Theory of Information-Access Regulation (SITIAR): Understanding the Psychology of Sharing and Withholding

Secrecy, privacy, confidentiality, concealment, disclosure, and gossip all involve sharing and withholding access to information. However, existing theories do not account for the fundamental similarity between these concepts. Accordingly, it is unclear when sharing and withholding access to information will have positive or negative effects and why these effects might occur. We argue that these problems can be addressed by conceptualizing these phenomena more broadly as different kinds of information-access regulation. Furthermore, we outline a social-identity theory of information-access regulation (SITIAR) that proposes that information-access regulation shapes shared social identity, explaining why people who have access to information feel a sense of togetherness with others who have the same access and a sense of separation from those who do not. This theoretical framework unifies diverse findings across disparate lines of research and generates a number of novel predictions about how information-access regulation affects individuals and groups.

'Shhh! Please don't tell…’ Confidentiality in child and adolescent mental health

Confidentiality in child and adolescent mental health is a complex and often challenging matter. Not only do young people frequently present to services in situations of risk, they often prefer to keep information confidential from parents and/or other professionals. This article explores confidentiality in the context of child and adolescent mental health services (CAMHS), particularly when the clinician is having to make decisions on whether to maintain or to breach it. Ethical principles (both deontological and consequentialist) and legal and regulatory frameworks (relating to human rights, case law and General Medical Council guidance) are outlined. Four hypothetical case scenarios are used to illustrate how to apply such principles: when a young person seeks confidential access to treatment, and when he or she discloses information that could signify a risk to self, to others or from others. Finally, practical suggestions on how to share information are explored.

Adolescent psychotherapy: an introduction

Adolescent psychotherapy has only recently taken hold as distinct from either child or adult psychotherapy. This new recognition was born of necessity as practitioners saw that theories and techniques developed for treating children and adults were far less effective for treating adolescents. As necessity is often the mother of invention, new models for treating adolescents have emerged. While these models differ in many respects, they share three characteristics: the unique features of adolescents, psychotherapists requiring specialized knowledge and skills, and the need for adolescent psychotherapy to involve the broader systemic context of the adolescent's life. The articles in this issue of In Session: Journal of Clinical Psychology insist that practitioners recognize and challenge their assumptions about how psychotherapy with adolescents should be conducted. The articles highlight the need for specialized training, the scarcity of evidenced-based research, and the ethical dilemmas that frequently occur when working with this population.