Conditions for Further Study: Proposed Suicidal Behavior Disorder

By Hart, Shelley R.; Smyth, Victoria | National Association of School Psychologists. Communique, January 1, 2017 | Go to article overview

Conditions for Further Study: Proposed Suicidal Behavior Disorder


Hart, Shelley R., Smyth, Victoria, National Association of School Psychologists. Communique


Although still a relatively rare occurrence, suicide is a leading cause of death for adolescents and young adults. In 2014, suicide was the second leading cause of death among those 10 to 24 years old (Centers for Disease Control [CDC], 2016). Disappointingly, despite being identified as a national priority (U. S. Department of Health and Human Services [DHHS)], 2012), in a recent brief released by the DHHS, suicide rates are reported to have almost steadily increased from 1999 through 2014 (Curtain, Warner, & Hedegaard, 2016). In fact, rates in 2014 were demonstrated to be 24% higher than in 1999, with greater annual percent increases occurring after 2006. While not as dramatic as has been observed within the general population, the rate of suicide deaths among adolescents 15 to 19 years of age has also increased (in particular since 2007; CDC, 2016).

While gender differences continue to exist (i.e., males die by suicide more often than females), the ratio was lower in 2014 (3.6:1) than in 1999 (4.5:1), indicating an increase in rates for females versus males. While increases for females occurred across all age groups, the increase was greatest among 10- to 14-yearolds (an increase of 200%; Curtain et al., 2016). Unfortunately, the National Institute of Mental Health (NIMH, 2016) reports that females ages 8 to 15 years old are 50% less likely to use mental health services.

Ethnic differences also exist, with White males continuing to have the highest suicide death rates (Curtain et al., 2016). However, this gap is also decreasing, in large part due to increases in the rates of African American males (Cash & Bridge, 2009). Also increasing are rates for other ethnic minority adolescents including Latino (particularly females), Asian American, Native American, Alaskan Native, and Hawaiian youth (Balis & Postolache, 2008).

Importantly, for every suicide death, it is estimated that there are 25 attempts (American Foundation for Suicide Prevention, 2016); that is, rates of suicidal behaviors are higher than deaths. According to the most recent Youth Risk Behavior Surveillance System, which is evaluating data collected in 2015, it was estimated that 17.1% of 9th through 12th graders had seriously considered attempting suicide, 14.6% had made a suicide plan, and 8.6% reported having attempted suicide in the 12 months precedingthe survey (Kann et al., 2016). Most disturbingly, 2.8% reported that their suicide attempt required medical treatment. Furthermore, since 2009, significant increases have been reported in suicidal thinking and in the percentage of high school students who report having made a suicide plan.

A history of suicidal behaviors is one of the most reliable predictors of suicide risk; however, these experiences may wax and wane, resulting in missing these important risk factors during clinical interviews (Oquendo, Currier, 8c Mann, 2006). Additionally, in clinical settings, current or past suicidal behaviors are typically only inquired about when in the presence of mood disorders or borderline personality disorder (Oquendo, Baca-Garcia, Mann, 8c Giner, 2008). Finally, much inconsistency has been demonstrated over time for individuals who reported a suicide attempt at one point, then deny it the following year, indicating that the current practice of inquiring about these behaviors may result in many individuals being missed (Hart, Musci, Ialongo, 8c Wilcox, 2013).

Taken together, these data imply that suicidal thoughts and behaviors are important to attend to; however, as mental and public health professionals, we are missing something, as the rates of suicide continue to grow. Clearly something must change. This is the argument promoting the addition of a new disorder to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association [APA], 2013). While this disorder was not officially entered into the DSM-5, the purpose of the chapter this proposed diagnosis is included in (i. …

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