American Academy of Pediatrics. Committee on Adolescence: Suicide and suicide attempts in adolescents and young adults.

Suicide is the third leading cause of death for adolescents 15 to 19 years old.1 Pediatricians can help prevent adolescent suicide by knowing the symptoms of depression and other presuicidal behavior. This statement updates the previous statement2 by the American Academy of Pediatrics and assists the pediatrician in the identification and management of the adolescent at risk for suicide. The extent to which pediatricians provide appropriate care for suicidal adolescents depends on their knowledge, skill, comfort with the topic, and ready access to appropriate community resources. All teenagers with suicidal symptoms should know that their pleas for assistance are heard and that pediatricians are willing to serve as advocates to help resolve the crisis. The number of adolescent deaths from suicide in the United States has increased dramatically during the past few decades. In 1997, there were 4186 suicides among people 15 to 24 years old, 1802 suicides among those 15 to 19 years old, and 2384 among those 20 to 24 years old.1 In 1997, 13% of all deaths in the 15through 24-yearold age group were attributable to suicide.1 The true number of deaths from suicide actually may be higher, because some of these deaths are recorded as “accidental.”3 From 1950 to 1990, the suicide rate for adolescents in the 15to 19-year-old group increased by 300%.4 Adolescent males 15 to 19 years old had a rate 6 times greater than the rate for females.1 The ratio of attempted suicides to completed suicides among adolescents is estimated to be 50:1 to 100:1, and the incidence of unsuccessful suicide attempts is higher among females than among males.5 Suicide affects young people from all races and socioeconomic groups, although some groups seem to have higher rates than others. Native American males have the highest suicide rate, African American women the lowest. A statewide survey of students in grades 7 through 12 found that 28.1% of bisexual and homosexual males and 20.5% of bisexual and homosexual females had reported attempting suicide.6 The National Youth Risk Behavior Survey of students in grades 9 through 12 indicated that nearly one fourth (24.1%) of students had seriously considered attempting suicide during the 12 months preceding the survey, 17.7% had made a specific plan, and 8.7% had made an attempt.7 Firearms, used in .67% of suicides, are the leading cause of death for males and females who commit suicide.8 More than 90% of suicide attempts involving a firearm are fatal because there is little chance for rescue. Firearms in the home, regardless of whether they are kept unloaded or stored locked up, are associated with a higher risk for adolescent suicide.9,10 Parents must be warned about the lethality of firearms in the home and be advised strongly to remove them from the premises.11 Ingestion of pills is the most common method among adolescents who attempt suicide. Youth, who seem to be at much greater risk from media exposure than adults, may imitate suicidal behavior seen on television.12 Media coverage of a teenage suicide may lead to cluster suicides, additional deaths from suicides in youths within a 1to 2-week period afterward.12–14 ADOLESCENTS AT INCREASED RISK Although no specific tests are capable of identifying suicidal persons, specific risk factors exist. Adolescents at higher risk commonly have a history of depression, a previous suicide attempt, a family history of psychiatric disorders (especially depression and suicidal behavior), family disruption, and certain chronic or debilitating physical disorders or psychiatric illness.15 Alcohol use and alcoholism indicate high risk for suicide.16 Alcohol use has been associated with 50% of suicides.17 Living out of the home (in a correctional facility or group home) and a history of physical or sexual abuse are additional factors more commonly found in adolescents who exhibit suicidal behavior.18 Psychosocial problems and stresses, such as conflicts with parents, breakup of a relationship, school difficulties or failure, legal difficulties, social isolation, and physical ailments (including hypochondriacal preoccupation), commonly are reported or observed in young people who attempt suicide. These precipitating factors often are cited by youths as reasons for attempting suicide. Gay and bisexual adolescents have been reported to exhibit high rates of depression and have been reported to have rates of suicidal ideation and attempts 3 times higher than other adolescents. Studies of twins show that monozygotic twins show significantly higher concordance for suicide than dizygotic twins.16 Long-term high levels of community violence may contribute to emotional and conduct problems and add to the risk of suicide for exposed youth.19 Adolescent and parent questionnaires that cover those risk factors listed above, may be useful in The recommendations in this statement do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. PEDIATRICS (ISSN 0031 4005). Copyright © 2000 by the American Acad-