Understanding Teens' Suicide Risk

Teenagers who attempt suicide or seriously consider share common characteristics

/ Author:  / Reviewed by: Robert Carlson, M.D

It may be difficult for some parents to distinguish between normal teenage angst and more serious symptoms of anxiety or depression. Teenagers who seriously consider suicide need help.

Therefore a group of researchers interviewed thousands of teens to get a better sense of what might contribute to suicidal thoughts or attempting suicide.

The researchers wanted to understand how common suicidal thoughts and attempts are among teens as well as the mental health of those teenagers and other patterns in their lives.

The study was led by Matthew K. Nock, PhD, of the Department of Psychology at Harvard University. It found that the vast majority of teens who had seriously considered, planned or attempted suicide had symptoms of a mental health disorder. This discovery and other information may help medical professionals and parents better understand the warning signs of a teen contemplating suicide.

"Suicide isn't the answer - call 1-800-273-8255."

The researchers conducted face-to-face interviews with 6,483 teens, aged 13 to 18, and collected questionnaires from their parents.

The interviews and questionnaires asked how often the teenager had seriously considered suicide, had planned a suicide and had attempted suicide. They also asked about health and mental health treatment the teens had received, as well as school services or juvenile justice experiences of the teens, if any.

The researchers gathered the families' demographic information, including education level and birth order of the teens. The teens also took a psychological assessment that was used with parent reports to identify possible disorder diagnoses in four broad areas.

These areas included fear and anger disorders (including phobias), distress and anxiety disorders (including post-traumatic stress disorder and depression), disruptive behavior disorders (including ADHD and eating disorders), and substance abuse. Researchers also assessed whether each teen may have had bipolar disorder using the teens' assessments and parents' reports.

The Influence of Mental Health on Suicidal Thoughts

The results revealed that 12.1 percent of teens have seriously considered suicide. A total of 4 percent reported actually planning a suicide and 4.1 percent reported attempting suicide.

Among the teens who have ever seriously considered suicide, 89 percent met the criteria for at least one of the 15 psychiatric disorders assessed in these participants. Nearly all – 96 percent – of those who attempted suicide met the criteria for at least one disorder.

The most common disorder found among the teens was major depressive disorder. Other common ones were specific phobia, oppositional defiant disorder, intermittent explosive disorder, substance abuse and conduct disorder.

Each disorder contributed a different level of risk to attempting suicide. Those with bipolar disorder were almost 9 times more likely to attempt suicide than those without a psychiatric disorder. Those with substance abuse disorders were about three to five times more likely to attempt suicide, and those with distress disorders were anywhere from four to 12 times more likely to attempt suicide.

Those who actually move from considering suicide to planning and/or attempting it usually do so within the first year that they start thinking about suicide. In fact, 86 percent of those who go from thinking about suicide to attempting it will attempt it within a year of their first suicidal thoughts.

Who Is Most at Risk in Attempting Suicide?

Girls are more likely to seriously consider suicide and are almost three times more likely to attempt it. However, boys are more likely to succeed because they more frequently choose firearms, the most lethal form of attempting suicide.

African-American teens both consider and attempt suicide at about half the rate of white or Hispanic teens. Teens whose parents have graduated high school or completed some college are two to three times more likely to attempt suicide than those whose parents had more or less education.

Teens were four times more likely to attempt suicide if they were not living with one of their parents than if they lived with both parents. Those living with just one parent were twice as likely to attempt suicide than those living with both parents.

The researchers also found that teens with two or more siblings have a slightly lower risk of attempting suicide. This finding and the lower risk among children of two-parent families may mean that having stronger social support helps reduce the risk of suicide, the researchers wrote.

Does Mental Health Treatment Help?

The researchers found that over 80 percent of teens who are suicidal receive some form of mental health treatment. More than 55 percent of suicidal teens begin receiving treatment before they have suicidal thoughts, yet the treatment does not necessarily prevent their suicidal thoughts, plans or attempts.

The researchers said their findings "argue strongly" for keeping a close watch on teens who have a suicide plan, especially from the first year they develop one.

"This information is important not only for a scientific understanding of suicidal behaviors but for the monitoring of risk among suicidal adolescents and for public health efforts to identify those at risk for attempting suicide," the researchers wrote.

The study was published January 8 in JAMA Psychiatry. The research was funded by the National Institute of Mental Health, the National Institute on Drug Abuse, the Substance Abuse and Mental Health Services Administration, the Robert Wood Johnson Foundation and the John W. Alden Trust.

Additional funding came from the Fogarty International Center of the National Institutes of Health, the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the Pan American Health Organization, and unrestricted educational grants from AstraZeneca, Bristol-Myers Squibb, Eli Lilly and Co, GlaxoSmithKline, Ortho-McNeil, Pfizer, sanofi-aventis and Wyeth.

Senior author Dr. Ronald Kessler has consulted for over two dozen companies and institutes, including about a dozen pharmaceutical companies. He has also served on advisory boards of pharmaceutical and other companies and received research support from these companies. No other conflicts of interest were noted.

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Review Date: 
January 8, 2013