Academic journal article International Public Health Journal

Public Health Aspects of Suicide in Children and Adolescents

Academic journal article International Public Health Journal

Public Health Aspects of Suicide in Children and Adolescents

Article excerpt


Child and adolescent suicide is a complex global public health problem that has intrigued researchers, academicians and policy makers for decades. Suicide is one of the leading causes of death; an estimated 30,000 people in the United States and 1 million people worldwide die of suicide. Global suicide rates have increased drastically, and lost U.S. productivity due to suicide is now estimated at $12 billion per year. The World Health Organization and United States (US) government have taken numerous steps toward establishing policies and prevention strategies, including calls for expanded collection of suicide data. Suicide also is one of the major causes of death in the adolescent population.

Despite the fact that progress has been made in our understanding of risk factors for suicide, it remains a major global medical burden. Among the 4 million suicide attempts yearly, about 90,000 adolescents succeed, averaging one successful attempt every 5 minutes; the cumulative result is that suicide is the 5th leading cause of adolescent death worldwide. In the following review, we will examine the current research on prevalence, risk factors and prevention strategies.


The U.S. adolescent suicide rate gradually increased during the 20th century, becoming more marked during the 1960s and reaching an overall peak in the 1990s, although there have been other significant peaks and troughs. Although adolescent suicide rates stabilized during the late 1990s, they had increased by 250% between 1960 and 1980 and doubled between 1960 and 2001. Since the late 1990s, the suicide rate has declined, reaching a 30-year low in 2003 (1). Numerous explanations for this reduction have been put forth, including earlier identification of at-risk teens, better and more focused delivery of mental health services to families in need and increased use of antidepressants. Unfortunately, this overall epidemiological trend shifted between 2000 and 2005, with a 14% increase in youth suicide during these years. This shift may have been due to reduced antidepressant prescribing amid the public health outcry and "black box" warnings regarding the association of antidepressant use with emergence of suicidal ideation.

The US Centers for Disease Control (CDC) recently published the National Suicide Statistics, with data updated to cover 2009, the latest year for which these numbers are available. According to the CDC, suicide rates declined in both sexes for the 1991-2000-time period but were consistently higher for 2001-2009. The CDC data also identifies numerous disturbing trends, including a 233% increase in suffocation suicide rates among females 10-24 years old. On the other hand, firearm suicide rates in females aged 10 to 24 years decreased from 1993 through 2007, while poisoning remained relatively constant at 0.48 suicides per 100,000 from 2002 to 2009. During 2005-2009, use of a firearm (29.7%) was the preferred mode of suicide among 1024 year-old males, but suffocation (48.5%) was more common among the equivalent female cohort. For the same group, firearms and suffocations caused the largest number of fatal self-injuries, while poisoning and cutting caused the fewest.

Demographically, group differences between males and females do not exist until mid-to-late adolescence (15-19 years), at which time the rate of suicide among males increases dramatically. During 2005-2009, the highest suicide rates were among American Indian/Alaskan Natives and Non-Hispanic Whites. Suffocation was the preferred method of suicide among American Indian/Alaskan Natives while Non-Hispanic Whites preferred firearms. Asian/Pacific Islanders had the lowest suicide rates among males, while Non-Hispanic Blacks had the lowest rates among females. In 2009, more female high school students planned (13% vs 8%) and attempted (8% vs 4%) suicide, as compared to their male peers (2).

Global suicide rates

Nationally recorded data on child and adolescent suicide must be interpreted with caution, as there are differences in data reporting among different nations. …

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