Adolescents and Suicide

Suicide is the third leading cause of death for persons 15 to 24 years old and the second leading cause of death for Caucasian non-Hispanic females 15-19 years old. The actual number of completed suicides is relatively small – approximately 12/100,000 males and 2/100,000 females ages 15-19 years. However, there are many more attempts, some resulting in serious injury and even permanent disabilities. According to the 2009 Youth Risk Behavior Surveillance (Center for Disease Control and Prevention), among high school students, 17% females and 10% males reported serious consideration of suicide in the past year, 13% females and 9% males reported having a suicide plan, and 8% females and 5% males stated they had made a suicide attempt. Roughly one-third of the attempts led to medical attention.

The most common means of suicide are firearms, suffocation/strangulation, and toxic ingestions. The strongest predictor of suicide is previous suicidal behavior. Risk factors for suicide include both mood and anxiety disorders, alcohol and/or drug use disorders, physical and/or sexual abuse history, and disruptive behavior disorders. Increased vulnerability to suicidal behavior has been observed in sexual minority and culturally alienated youth and in adolescents who have recent experience of the suicide of a friend, sibling, or other family member.

Obstetrician/gynecologists and other providers of health care to adolescents are very likely to encounter patients who are at risk for suicide. It is not harmful and may be extremely helpful to ask a youth if she or he has ever considered suicide, if she or he has current thoughts of suicide, and, if so, if she or he has a plan for how, where, and when. Adolescents who admit serious consideration of suicide require prompt referral to a crisis mental health agency or emergency department for further assessment.

The following resources provide additional information for the interested health professional, parent, or adolescent. If a parent is concerned about suicide risk in his/her child, he/she should consult the child’s primary health care health professional for guidance and appropriate treatment and/or referral.

The following resources are available from ACOG:

American College of Obstetricians and Gynecologists. Mental health disorders in adolescents. In: Guidelines for adolescent health care. Washington, DC: American College of Obstetricians and Gynecologists; 2011. p. 85-96.

American College of Obstetricians and Gynecologists. Fact sheet: depression. In: Tool kit for teen care. 2nd ed. Washington, DC: ACOG; 2009.

American College of Obstetricians and Gynecologists. Depression: a fact sheet for parents. In: Tool kit for teen care. 2nd ed. Washington, DC: ACOG; 2009.

The references and resources listed below are for information purposes only. Referral to these sources and sites does not imply the endorsement of ACOG. Further, ACOG does not endorse any commercial products that may be advertised or available from these organizations or on these websites. These lists are not meant to be comprehensive. The exclusion of a source or site does not reflect the quality of that source or site. Please note that sites and URLs are subject to change without notice.

REFERENCES FOR PROFESSIONALS

General

Practice parameter for the assessment and treatment of children and adolescents with suicidal behavior. American Academy of Child and Adolescent Psychiatry. J Am Acad Child Adolesc Psychiatry 2001;40:24S-51S.

Brookman RR, Sood AA. Disorders of mood and anxiety in adolescents. Adolesc Med Clin 2006;17:79-95.

Edelsohn GA, Gomez JP. Psychiatric emergencies in adolescents. Adolesc Med Clin 2006;17:183-204.

Gould MS, Greenberg T, Velting DM, Shaffer D. Youth suicide risk and preventive interventions: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry 2003;42:386-405.

Greydanus DE, Calles J Jr. Suicide in children and adolescents. Prim Care 2007;34:259-73; abstract vi.

Hatcher-Kay C, King CA. Depression and suicide. Pediatr Rev 2003;24:363-71.

Prager LM. Depression and suicide in children and adolescents [published erratum appears in Pediatr Rev 2009;30:310]. Pediatr Rev 2009;30:199-205; quiz 206.

Shain BN, AAP Committee on Adolescence. Suicide and suicide attempts in adolescents. Clinical Report. American Academy of Pediatrics. Pediatrics 2007;120:669-76.

Stewart SE, Manion IG, Davidson S. Emergency management of the adolescent suicide attempter: a review of the literature. J Adolesc Health 2002;30:312-25.

Waldvogel JL, Rueter M, Oberg CN. Adolescent suicide: risk factors and prevention strategies. Curr Probl Pediatr Adolesc Health Care 2008;38:110-25.

Epidemiology

Colucci E, Martin G. Ethnocultural aspects of suicide in young people: a systematic literature review part 1: Rates and methods of youth suicide. Suicide Life Threat Behav 2007;37:197-221

Colucci E, Martin G. Ethnocultural aspects of suicide in young people: a systematic literature review part 2. Risk factors, precipitating agents, and attitudes toward suicide. Suicide Life Threat Behav 2007;37:222-37.

Eaton DK, Kann L, Kinchen S, Shanklin S, Ross J, Hawkins J, et al. Youth risk behavior surveillance - United States, 2009. Centers for Disease Control and Prevention (CDC). MMWR Surveill Summ 2010;59(SS-5):1-142. Available at: http://www.cdc.gov/mmwr/pdf/ss/ss5905.pdf. Retrieved December 6, 2011.

Evans E, Hawton K, Rodham K, Deeks J. The prevalence of suicidal phenomena in adolescents: a systematic review of population-based studies. Suicide Life Threat Behav 2005;35:239-50.

Hatzenbuehler ML. The social environment and suicide attempts in lesbian, gay, and bisexual youth. Pediatrics 2011;127:896-903.

Kaminski JW, Fang X. Victimization by peers and adolescent suicide in three US samples. J Pediatr 2009;155:683-8.

Prevention

Cheung AH, Zuckerbrot RA, Jensen PS, Ghalib K, Laraque D, Stein RE. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): II. Treatment and ongoing management. GLAD-PC Steering Group [published erratum appears in Pediatrics 2008;121:227]. Pediatrics 2007;120:e1313-26.

Gardner W, Klima J, Chisolm D, Feehan H, Bridge J, Campo J, et al. Screening, triage, and referral of patients who report suicidal thought during a primary care visit. Pediatrics 2010;125:945-52.

Gladstone TR, Beardslee WR, O'Connor EE. The prevention of adolescent depression. Psychiatr Clin North Am 2011;34:35-52.

Gould MS, Kramer RA. Youth suicide prevention. Suicide Life Threat Behav 2001;31(suppl):6-31.

Mann JJ, Apter A, Bertolote J, Beautrais A, Currier D, Haas A, et al. Suicide prevention strategies: a systematic review. JAMA 2005;294:2064-74.

Pena JB, Caine ED. Screening as an approach for adolescent suicide prevention. Suicide Life Threat Behav 2006;36:614-37.

Screening and treatment for major depressive disorder in children and adolescents: US Preventive Services Task Force Recommendation Statement. US Preventive Services Task Force [published erratum appears in Pediatrics 2009;123:1611]. Pediatrics 2009;123:1223-8.

Wintersteen MB. Standardized screening for suicidal adolescents in primary care. Pediatrics 2010;125:938-44.

Zuckerbrot RA, Cheung AH, Jensen PS, Stein RE, Laraque D, GLAD-PC Steering Group. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): I. Identification, assessment, and initial management. Pediatrics 2007;120:e1299-312.

Zuckerbrot RA, Jensen PS. Improving recognition of adolescent depression in primary care. Arch Pediatr Adolesc Med 2006;160:694-704..

Impact on Others

Adler RS, Jellinek MS. After teen suicide: issues for pediatricians who are asked to consult to schools. Pediatrics 1990;86:982-7.

Feigelman W, Gorman BS. Assessing the effects of peer suicide on youth suicide. Suicide Life Threat Behav 2008;38:181-94.

Girard GA, Silber TJ. The aftermath of adolescent suicide: clinical, ethical, and spiritual issues. Adolesc Med State Art Rev 2011;22:229-39, ix.

Books for Professionals, Parents

Balk DE, Corr CA. Adolescent encounters with death, bereavement, and coping. New York (NY): Springer; 2009.

Berman AL, Jobes DA, Silverman MM. Adolescent suicide: assessment and intervention. 2nd ed. Washington, DC: American Psychological Association; 2006.

Griffith G. Will’s choice: a suicidal teen, a desperate mother, and a chronicle of recovery. New York (NY): HarperCollins; 2005.

Gutierrez PM, Osman A. Adolescent suicide: an integrated approach to the assessment of risk and protective factors. DeKalb (IL): Northern Illinois University Press; 2008.

Haugen DM, Box MJ, editors. Suicide. Farmington Hills (MI): Greenhaven Press/Thomson Gale; 2006.

Hawton K, Rodham K. By their own young hand: deliberate self-harm and suicidal ideas in adolescents. Philadelphia (PA): Jessica Kingsley; 2006.

King RA, Apter A. Suicide in children and adolescents. New York (NY): Cambridge University Press; 2003.

Lezine DA, Brent D. Eight stories up: an adolescent chooses hope over suicide. New York (NY): Oxford University Press; 2008.

Osborne M. The inner world of a suicidal youth: what every parent and health professional should know. Westport (CT): Praeger; 2008.

Portner J. One in thirteen: the silent epidemic of teen suicide. Beltsville (MD): Robins Lane Press; 2001.

Schusterbauer E, editor. Teen suicide. Detroit (MI): Greenhaven Press; 2009.

Spirito A, Overholser JC. Evaluating and treating adolescent suicide attempters: from research to practice. San Diego (CA): Academic Press; 2003.

Books for Adolescents

Bornstein K. Hello, cruel world: 101 alternatives to suicide for teens, freaks, and other outlaws. New York (NY): Seven Stories Press; 2006.

Nelson RE, Galas JC. The power to prevent suicide: a guide for teens helping teens. Updated ed. Minneapolis (MN): Free Spirit; 2006.

Wohlenhaus K, editor. Suicide information for teens: health tips about suicide causes and prevention: including facts about depression, risk factors, getting help, survivor support, and more. 2nd ed. Detroit (MI): Omnigraphics; 2010.

Organizations/Websites

American Academy of Child and Adolescent Psychiatry
www.aacap.org

Pamphlet: Facts for families: teen suicide

American Academy of Family Physicians
www.aafp.org/online/en/home.html

http://familydoctor.org/familydoctor/en/teens/emotional-well-being.html http://familydoctor.org/familydoctor/en/prevention-wellness/emotional-wellbeing/mental-health/grieving-facing-illness-death-and-other-losses.html

American Academy of Pediatrics
www.aap.org

Pamphlet: Teen suicide, mood disorder, and depression

American Association of Suicidology
www.suicidology.org/web/guest/home

Fact sheet:Youth suicidal behavior

American Psychiatric Association
www.psych.org

Channing Bete
www.channing-bete.com

Booklets:   About Suicide
       Suicide – A Cry for Help
       Suicide Among Young People
Pamphlets: Preventing Suicide: Choosing to Live
       Preventing Suicide: How You Can Help

ETR Associates
www.etr.org

Pamphlets: Suicide Talk: What To Do If You Hear it
      Suicide Thoughts
      Suicide: Who Is At Risk

Krames
www.krames.com

Booklet:  About Suicide: From Depression to Hope

Mental Health America
www.nmha.org

National Institute of Mental Health
www.nimh.nih.gov/index.shtml

National Suicide Prevention Lifeline
www.suicidepreventionlifeline.org 

Hotline: 1-800-273-TALK (8255)

The Prevention Researcher
www.tpronline.org

Adolescent self-injury. Prev Res 2010;17(1).
Adolescent stress, depression and suicide. Resource Issue 2006. Prev Res 2006;13(suppl).
Teen suicide prevention. Prev Res 2006;13(3).

TeenScreen: National Center for Mental Health Checkups at Columbia University
www.teenscreen.org

Fact sheet: Youth Suicide and Prevention

Contact:

Caitlin Phelps, MA
Director of Gynecology
clinical@acog.org

Lyndona Charles
Special Assistant, Gynecology and Ethics
lcharles@acog.org