Suicidal Behaviour in Children and Adolescents

Suicidal behaviour is an action intended to harm oneself and includes suicide gestures, suicide attempts, and completed suicide.

Suicidal ideation is thoughts and plans about suicide.

Suicide attempts are acts of self-harm that could result in death, such as hanging or drowning.

• A stressful event may trigger suicide in children who have a mental health disorder such as depression.
• Children at risk of suicide may be depressed or anxious, withdraw from activities, talk about subjects related to death, or suddenly change their behaviour.
• Family members and friends should take all suicide threats or attempts seriously.
• Health care practitioners try to determine how serious the risk of suicide is.
• Treatment may involve hospitalisation if the risk is high, drugs to treat other mental health disorders, and individual and family counselling.

Refer to Suicidal Behaviour in adults.

Suicide is rare in children before puberty and is mainly a problem of adolescence, particularly between the ages of 15 and 19, and of adulthood.

However, pre-adolescent children do commit suicide, and this potential problem must not be overlooked.

In the United States, suicide is the second or third leading cause of death in adolescents. It results in 2,000 deaths per year. It is also likely that a number of the deaths attributed to accidents, such as those due to motor vehicles and firearms, are actually suicides.

Many more young people attempt suicide than actually succeed. In the US in 2015:

• 17% of high school students seriously considered attempting suicide in the previous year.
• 13% made a suicide plan in the previous year.
• 8% of students attempted suicide one or more times in the previous year.
• 29% of lesbian, gay, or bisexual (LGB) students attempted suicide at least once in the previous year compared with 6% of heterosexual high school students.

Frequently, suicide attempts involve at least some ambivalence about wishing to die and may be a cry for help.

Among adolescents in the United States, boys outnumber girls in completed suicide by more than 4 to 1. However, girls are 2 to 3 times more likely to attempt suicide.

Risk Factors

Suicidal thoughts do not always lead to suicidal behaviour, but they are a risk factor for suicidal behaviour.

Several factors typically interact before suicidal thoughts become suicidal behaviour. Very often, there is an underlying mental health disorder and a stressful event that triggers the behaviour.

Stressful events include:

• Death of a loved one.
• A suicide in school or another group of peers.
• Loss of a boyfriend or girlfriend.
• A move from familiar surroundings (such as the school or neighborhood) or friends.
• Humiliation by family members or friends.
• Being bullied at school, especially for lesbian, gay, bisexual, and transgender (LGBT) students.
• Failure at school.
• Trouble with the law.

However, such stressful events are fairly common among children and rarely lead to suicidal behavior if there are no other underlying problems.

The most common underlying problems are the following:

• Depression: Children or adolescents with depression have feelings of hopelessness and helplessness that limit their ability to consider alternative solutions to immediate problems.
• Alcohol or drug abuse: The use of alcohol or drugs lowers inhibitions against dangerous actions and interferes with anticipation of consequences.
• Poor impulse control: Adolescents, particularly those who have a disruptive behavioural disorder such as conduct disorder, may act without thinking.

Other mental disorders and physical disorders can also increase the risk of suicide. They include anxiety, schizophrenia, head injury, and post-traumatic stress disorder.

Children and adolescents attempting suicide are sometimes angry with family members or friends, are unable to tolerate the anger, and turn the anger against themselves. They may wish to manipulate or punish other people (“They will be sorry after I am dead”). Having difficulty communicating with their parents may contribute to the risk of suicide.

Sometimes suicidal behaviour results when a child imitates the actions of others. For example, a well-publicised suicide, such as that of a celebrity, is often followed by other suicides or suicide attempts. Similarly, copycat suicides sometimes occur in schools.

Suicide is more likely in families in which mood disorders are common, especially if there is a family history of suicide or other violent behaviour.