The child who expresses a desire to hurt himself or herself poses a serious concern that must be addressed. Suicide is the third leading cause of death among children 10 to 19 years old. There were close to 2,000 reported cases of suicide among children in 2004, accounting for 12.5% of all deaths among adolescents. The magnitude of the problem is probably even greater, given that underreporting is a known phenomenon. Depression leading to suicide is often unrecognized and, frequently, goes untreated due to poor access to health care and reticence to access mental health services.

When surveyed, nearly 25% of students in grades 9 to 12 reported that they seriously considered attempting suicide during the preceding 12 months. Almost 1 in 10 (8.7%) high school students has made an attempt. Among those who attempt suicide, 1% to 2% succeeds, with the incidence of completed suicide higher among boys than girls. Suicide attempts using guns are very concerning, as 90% of attempts with guns are fatal, making firearms the leading cause of death in youths who commit suicide.

Clearly, it is incumbent on the pediatrician to know risk factors associated with suicide as well as signs and symptoms of depression. Factors associated with a higher risk of suicide include: