In a recently released issue of Pediatrics(10.1542/peds.2019-3823), Dr. Massimiliano Orri and colleagues examine the prevalence of suicide-related outcomes, and their association with mental health problems among teens and young adults ages 13-20 years, with a focus on age-based differences. The authors used a birth cohort born in 1997-8 in the Canadian province of Québec who were enrolled in a longitudinal ongoing population-based study, The Québec Longitudinal Study of Child Development. This unique study followed a representative sample of singleton infants assessed bi-annually from age 5 months through age 20 years. This study included the 1,618 individuals (76% of the initially evaluated cohort of 2120 infants) for whom (self-reported) measures of suicidal ideation and attempts were available at ages 13, 15, 17 or 20 years. Participants were asked, “Did you ever think about suicide?” (passive suicidal ideation), “Did you ever seriously think about committing suicide?” (serious suicidal ideation), and (if yes), “How many times did you attempt suicide?” Information on 5 mental health problems (depression, anxiety, oppositional/defiance, conduct and attention deficit and/or hyperactivity) was taken from standardized, validated self-report questionnaires, which are available to readers in full in the Appendix. Using this rich data set, the authors were able to identify associations between each mental health problem and each suicide-related outcome across the ages of interest.
Overall, rates of suicidal ideation and attempt were highly concerning: lifetime prevalence for passive suicidal ideation was 21.7% (to emphasize, one of 5 teens), for serious suicidal ideation was 11.9%, and for suicide attempt was 6.7%. Although males are more likely to have completed suicide attempts (22.7/100,000 population for males versus 5.8/100,000 population for females among ages 15-24 years)1, Dr. Orri and colleagues here found the prevalence of suicide-related outcomes was nearly double for females as compared to males (completed suicides were not assessed in this study). While rates of both passive and serious suicidal ideation increased over adolescence, the rate of suicide attempts actually changed little over adolescence, and was similar for both sexes.
The authors walk us through associations of mental health problems with suicide-related outcomes at each age (13, 15, 17 and 20 years) and then summarize the multivariable results. While the CDC emphasizes that more than half (54%) of those with completed suicide do not have a mental health diagnosis2, this study helps us see clearly how mental health conditions are associated with risk for suicidal ideation and attempts. For example, depression (at ages 13 and 20 years) and conduct problems (at ages 13, 15 and 20 years) were associated with suicide attempts. This study unveils associations between mental health problems and suicidality that can guide our understanding of which adolescents may be at higher risk.
Overall, though, the message for clinicians is clear: we need to screen all teens for suicidality. Those with mental health problems or symptoms will benefit from treatment referral. And given what this study unveils about suicidal thinking and suicide attempts among adolescents, we should listen carefully to each teen at each visit over the near decade that we provide their care. Additional excellent resources are available on the CDC page cited.2
1. Deaths per 100,000 resident population by suicide in the U.S. in 2017, by gender and age. Statista 2020. https://www.statista.com/statistics/187496/death-rate-from-suicide-in-the-us-bygender-and-age/
2. Suicide rising across the US. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 2018. https://www.cdc.gov/vitalsigns/suicide/index.html