Suicide: Pediatric Mental Health Minute Series

Suicide is the act of intentionally causing one's own death. Based on the most recent statistics for the United States (U.S.), suicide is the second leading cause of death for children, adolescents, and young adults, ages 10-24 years.

Scope in Pediatrics

• Youth suicide is a serious public health problem, responsible for more deaths among youths ages 10 to 24 years than any single major medical illness. While rare in children younger than 10 years, suicide death rates increase markedly during adolescence and young adulthood. Pediatric suicide rates have increased significantly in the U.S., nearly tripling between 2007 and 2017 among children ages 10 to 14 years.
• Non-fatal suicide attempts are more common, particularly in adolescents and young adults where some estimates have suggested there are roughly 100-200 suicide attempts for every suicide death. National surveillance data suggest that roughly 7-8% of adolescents attempt suicide each year, and roughly 17% report serious suicidal ideation. Roughly 157,000 individuals between the ages of 10 and 24 receive emergency medical care for intentional self-inflicted injuries.
• Non-Suicidal Self-Injuries (NSSI), like cutting and burning oneself with no suicidal intent, is more common than suicide attempts, estimated to occur in roughly 17-18% of adolescents. While NSSI is often described as an effort to relieve distress, NSSI has been found to predict suicide attempts, a predictor of later death by suicide.
• Even when a patient denies suicidal ideation when engaging in NSSI or self-harm with unclear intent, the patient’s risk is considered elevated due to the increased risk of later more dangerous self-harm behavior.

Teaching Points

• Evaluation and management of suicide and self-harm risk is feasible in pediatric care.
• This process involves 4 steps: ABCD
  Assess risk
  Build hope and reasons for living
  Connect, strengthen connections with protective adults
  Develop safety plan
• Screening tools, risk stratification protocols, and clinical pathways have been developed to support primary care evaluation and management of suicide and self-harm risk.
• Traumatic stress is associated with increased risk of suicidal and self-harm behavior, underscoring the need for a trauma-informed approach.
• Every practice and clinic is different, and your approach will need to be developed to fit your practice and resources.