Suicide
Heather Walter
Phillip Hernandez
Joanna Cole
I. Description of the problem. Suicide ranks as the third and fourth leading cause of death among young people aged 15 to 24 and 10 to 14 years, respectively. Each year, there are approximately 10 suicides for every 100,000 youngsters less than age 19, an estimated 12 suicides every day. Research implicates a number of psychological, biological, environmental, social, and cultural risk factors for suicide, and knowledge of these risk factors can facilitate pediatric clinicians’ identification and management of youths at highest risk.
Suicidality presents on a dimensional spectrum ranging from thoughts about causing intentional self-injury or death (suicidal ideation) to acts that cause intentional self-injury (suicide attempt) or death (completed suicide). The intent to harm oneself, which may be explicit and strong or ambiguous and vague, is the defining characteristic of suicidal behavior. Intentionality is complicated by developmental variations among children and adolescents.
A. Epidemiology. Suicide is rare before puberty. Rates of completed suicide increase steadily across the teen years, rising from 1.3 per 100,000 in 10- to 14-year-olds to 8.2 per 100,000 in 15- to 19-year-olds. Teenage/young adult males complete suicide at a rate four times that of females and represent nearly 80% of all suicides. Suicide rates are highest among American Indian/Alaska Native youths (15.1 per 100,000) and non-Hispanic whites (13.9 per 100,000). Rates are lowest among Asia/Pacific youths (5.7 per 100,000), non-Hispanic blacks (5.0 per 100,000), and Hispanics (4.9 per 100,000). From 1950 to 1990, the suicide rate for adolescents aged 15 to 19 years increased by 300%. Firearms remain the most commonly utilized method of completing suicide for males, whereas females are more likely to complete suicide by poisoning. Hanging/suffocation is gaining prominence as a common method, especially among children and among females. Firearms in the home, regardless of whether they are kept unloaded or locked, are associated with a higher risk of completed adolescent suicide.
Although reliable data for suicide attempts is difficult to obtain, it is estimated that for every completed youth suicide, as many as 200 attempts are made. Ingestion of medication is the most common method of attempted suicide. Attempts are more common in girls than boys (approximately 3:1), and in Hispanic girls and gay, lesbian, and bisexual youths. Attempters who have made prior suicide attempts, who used a method other than ingestion, and who still want to die are at increased risk of completed suicide.
On the basis of the 2007 Youth Risk Behavior Survey, 14.5% of students in grades 9 through 12 reported that they had seriously considered attempting suicide in the 12 months preceding the survey (18.7% of females and 10.3% of males). Nearly 7% of students reported that they had actually attempted suicide one or more times during the same period.
B. Developmental considerations. Young children do not know that death is final. Comprehension of the finality of death may fluctuate throughout early childhood and is not fully realized until adolescence. Similarly, intentionality may be difficult to ascertain in pre-adolescents. As such, children who commit self-injurious acts should be considered potentially suicidal even in the absence of clearly stated intent. Young children are more susceptible to accidental suicide through imitation or suggestion.
C. Risk factors.
1. Psychiatric disorders.
A prior history of a suicide attempt increased the risk of suicide nearly 90-fold. Approximately 90% of these youths who completed suicide had a psychiatric disorder at the time of death, and more than 70% had multiple disorders. A large proportion of youths with psychiatric disorders at the time of suicide had not sought or been provided with treatment. The most common disorders, found in 60% to 75% of youths who completed suicide, were mood disorders, which together increased the likelihood of committing suicide 8- to 13-fold. Rates of major depressive disorder ranged from 30% to 50% among suicide victims, and the likelihood of committing suicide was increased 27-fold by the
presence of a current episode of major depression. Approximately one-fifth of youth suicide victims were diagnosed with bipolar disorder, which increased the likelihood of completed suicide nine-fold.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
