Suicide is a major public health problem in the United States, and suicide and attempted suicide are important causes of morbidity and mortality in adolescents. It is important for clinicians to recognize risk factors for suicide and to screen all adolescents for suicidal thoughts and feelings. Outlined here are the important facts about adolescents and suicide.
 
 

Epidemiology

• More people die from suicide than from homicide: In 1998, there were 1.7 times as many suicides as homicides.
• Overall, suicide is the 8^th leading cause of death for all Americans in the United States
• Approximately 500,000 people need emergency room treatment as a result of attempted suicide
• For young people, 15-24 years of age, suicide is the 3^rd leading cause of death.
• Suicide has increased in prevalence in younger children as well- it is the 4^th leading cause of death in the 10 to 14 year old age group.
• Adolescent females are more likely to attempt suicide.
• Adolescent males are more likely to complete suicide, actually they are 4 times more likely to complete suicide than females.
• White and Native American populations have significantly higher rates of suicide than African American, Latino or Asian populations.
• Gay youth may be 2 to 3 times more likely to attempt suicide as compared to their peers. This is more prevalent in homosexual/bisexual males, who in some studies have been found to be 7 time more likely to have suicide attempts.

Risk factors:

• Mood Disorder
• Alcohol and/or substance abuse
• Conduct disorder
• Personality disorders
• Impulsive behavior
• Violent behavior
• Chronic physical illness
• Being isolated
• Real or imagined loss (relationships, school or financial losses)
• Gay, lesbian, bisexual, transgender or questioning youth, especially males
• Previous suicide attempt

• Physical or sexual abuse of children in the family
• Family history of mental health issues or substance abuse
• Family history of suicidal behavior
• Familial conflict and stress (death, divorce)

• Access to lethal methods (especially firearms)
• Local suicide epidemics
• Barriers to access mental health treatment

Personal

• Problem solving skills
• Religious beliefs
• Academic achievement

• Family support and connectedness

• Support from medical and mental health providers
• No access to lethal methods
• Community and school support/connectedness

• There is no evidence that asking about suicide will bring about suicidal behavior.
• Suicidal comments MUST be discussed with any teen.
• Common symptoms: frequent crying, isolation, weight loss or gain, fatigue, insomnia.
• Some symptoms are more common in adolescents: irritability, behavior problems, violence issues, vague systemic complaints like headache, abdominal pain, syncope
• Always ask about grades, drug abuse, sexual promiscuity and truancy. These may be clues to possible suicidal behavior
• If a teen admits to suicidal thoughts, ask if he or she has plans, a means to commit suicide, and if there are prior attempts.
• Adolescents must be made aware that this is one of the rare occasions in which strict confidentiality may not be kept. This will have to be assessed on an individual case basis assessment of risk.
• For adolescents at low risk-those feeling sad, but who have no plans of history of attempts, should have an appointment set up with a mental health professional.
• For those who are at moderate or high risk, an emergent evaluation by a mental health professional is in order.
• An actively suicidal adolescent needs a complete medical and psychiatric evaluation as well as initiation in a controlled setting. Interventions are going to depend on the needs and resources of specific patients. Is the family supportive? Is there a history of prior attempts? Does the patient have co-morbid drug or alcohol abuse?

References
1. Brent David and Birmaher,Boris  Adolescent Depression NEJM Vol 347 No. 9 August 29, 2002
2. Vitello B. Swedo S. Antidepressant Medications in Children NEJM 350 April 8 2004 Page 1489
3. Newman T. A Black-Box Warning for Antidepressants in Children?  NEJM Oct. 14, 2004
4. Mann J. The Medical Management of Depression.  NEJM October 27, 2005
5. Brent D.A. Mann J.J. Familial Pathways to Suicidal Behavior-Understanding and Preventing Suicide Risk When Treating Adolescent. NEJM Dec 28, 2006
6. Simon G.E. The Antidepressant Quandry-Considering Suicide When Treating Adolescent Depression.  NEJM Dec. 28, 2006