Les adolescents qui consultent dans les services d’accueil et d’urgence (SAU) après une tentative de suicide sont une population particulièrement à risque de récidive. Des soins existent, mais la mauvaise observance du suivi post-urgence à l’adolescence et en particulier dans ce contexte, les rend peu efficaces. Nous proposons de résumer la littérature internationale sur les interventions au SAU favorisant l’observance des soins proposés aux adolescents admis pour tentatives de suicide.

Revue exhaustive des articles répertoriés dans les bases PubMed, PsycInfo, et des archives en ligne des revues spécialisées dans la suicidologie (Crisis, Suicide and Life-Threatening Behavior) et l’adolescence (Journal of the American Academy of Child and Adolescent Psychiatry, Journal of Adolescent Health, Neuropsychiatrie de l’enfance et de l’adolescence), sur la période janvier 1990 à juin 2017. Quatorze articles inclus présentés sous une forme de revue narrative.

Les interventions sont classées en trois groupes : les interventions se déroulant uniquement au sein du SAU, et les interventions sur la transition SAU–post-SAU, auxquelles il faut ajouter les interventions en amont de la prise en charge. Les interventions qui semblent les plus efficaces sont celles qui ciblent la transition, qui sont mises en place le plus rapidement à la sortie, qui incluent activement les parents, et qui travaillent sur les barrières au traitement.

L’efficacité des approches de transition à court terme ne permet pas de conclure à plus long terme. Il n’existe aujourd’hui pas de dispositif idéal pour améliorer l’adhésion aux soins des adolescents après une tentative de suicide. Les pistes doivent être approfondies et étudiées de manière quantitative mais également qualitative.

Suicidal adolescents admitted in an Emergency Department (ED) present a high risk of suicidal reattempts. Poor observance of follow-up in this particular group imped the efficacity of the treatment. We propose to summarize the international literature on ED interventions promoting suicidal adolescents’ adherence to care.

We carried out a comprehensive review of papers listed in PubMed, PsycInfo, and CINHAL databases using keywords about adolescence, suicide, and ED. We also manually consulted the main journals specialized in suicidology (Crisis and Suicide and Life-Threatening Behavior) and adolescence (Journal of the American Academy of Child and Adolescent Psychiatry, Journal of Adolescent Health, Neuropsychiatrie de l’Enfance et de l’Adolescence). We selected the relevant articles describing or evaluating one or more interventions initiated in the ED and designed to promote adolescent adherence to post-emergency care. The results are presented in a narrative review form.

Interventions are organized in three groups: interventions that take place solely at the ED (problem-solving interventions and educational interventions directed to families) and interventions that take place during and after emergency care (we included in this group the ED-Care program, the FISP program, and the SAFETY program), to which should be added interventions that take place prior to care, in particular specific trainings for medical and paramedical teams. Small samples and barriers in measuring adherence to care make statistical comparisons difficult, yet the interventions that seem most effective are those that target the time both during and after ED discharge, those which are implemented most rapidly after discharge, those which actively include parents, and those which involve an implication of the families about barriers to follow-up.

Our results show an effectiveness of complete programs on short-term compliance but no conclusion can be drawn on long-term effects. Most comprehensive care programs are based on the principle of adolescent compliance, which remains problematic. Until today, no ideal protocol exists to improve short-term as well as long-term compliance to care among adolescents after a suicide attempt. We have to improve our understanding of facilitators and barriers to follow-up using quantitative as well as qualitative research studies. Although it is well established that parents’ involvement in the early stages of care is essential, little is known about the underlying processes. In these situations, qualitative studies could help to better target interventions that lead more particularly to follow up compliance in adolescence.