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Suicidal behavior in children and adolescents: Epidemiology and risk factors

Stephanie Kennebeck, MD
Liza Bonin, PhD
Section Editor
David Brent, MD
Deputy Editor
David Solomon, MD


Suicidal behavior includes the spectrum from thoughts or ideas that revolve around suicide or death (suicidal ideation) through fatal completion of suicide [1,2]. Between these extremes are suicide threats and suicide attempts (potentially self-injurious action with a nonfatal outcome for which there is evidence that the individual intended to kill him- or herself) [1]. Children and adolescents who present for medical attention with suicidal behavior require a variable amount of medical, social, and psychiatric intervention depending upon the seriousness of their intent, their underlying risk factors, and their emotional support system.

The epidemiology of and risk factors for childhood and adolescent suicide will be reviewed here. The evaluation and management of children and adolescents with suicidal ideation are discussed separately. (See "Suicidal behavior in children and adolescents: Evaluation and management".)


Prevalence — Suicide is an important public health problem for children and adolescents around the world [3-8]. In the United States, suicide rates doubled in the 15- to 19-year age group and tripled in the 10- to 14-year age group between the 1960s and the 1990s [9]. The reasons for this trend are unclear, although it is not simply because of increased reporting [10]. Possible explanations include increased rates of alcohol and drug abuse, depression, family and social disorganization, and access to firearms [10,11].

Suicide is the third leading cause of death among all children and adolescents in the United States, including those aged 10 to 19 years (table 1) [12,13]. Adolescent suicide rates declined somewhat between the late 1980s and 2003, but increased between 2003 and 2004 [14,15], and again between 2008 and 2009 [13]. In 2009, there were 1922 suicides reported for children younger than 19 years [13]. Suicide accounted for 14 percent of deaths in adolescents aged 15 to 19 years, and 8 percent of deaths in children aged 10 to 14 years.

Between 2003 and 2004, suicide rates increased among females aged 10 to 14 years (by 76 percent), females aged 15 to 19 years (by 32 percent), and males aged 15 to 19 years (by 9 percent) (figure 1) [15]. The reasons for this increase are not clear; possible explanations include the misclassification of unintentional asphyxia from adolescents playing "the choking game" (ie, intentionally restricting the supply of oxygenation to the brain, often with a ligature, to induce a brief euphoria) and changes in risk factors for suicide or suicide methods [15-17]. The potential impact of the United States Food and Drug Administration warning regarding the risk of suicidality and antidepressants on the rates of antidepressant prescriptions and suicide is discussed separately. (See "The "choking game" and other strangulation activities in children and adolescents" and "Effect of antidepressants on suicide risk in children and adolescents".)


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