Background

Rates of completed suicide in the United States have risen consistently over the last two decades, with significant increases occurring in 44 states. Suicide is the second leading cause of death in children and adolescents between ages 10 and 19. In addition to deaths from suicide, experiences of suicidal thoughts and suicide attempts are common among children, adolescents, and young adults: approximately 157,000 youth are treated in emergency rooms annually for self-inflicted injuries, and 8% of American high school students report a suicide attempt in the previous year. Untreated or ineffectively treated mental illness is a crucial risk factor for suicide, and yet many individuals at risk for suicide are not being identified for mental health intervention. In addition to history of mental illness, additional risk factors among children and youth include exposure to violence, experience of abuse and neglect, peer rejection, lack of social support connections, and emotion dysregulation. Observable signs of risk for suicide include seeking means to kill oneself; thinking, talking about, or threatening suicide; thoughts and feelings of hopelessness, purposelessness, not belonging; withdrawing from people and activities; non-suicidal self-injury; substance abuse; and expressions of unusual anger, mood changes, and recklessness. In addition, seeking out Internet sites that provide information about suicide and self-harm is now considered a significant warning sign of suicide intent.

The American Academy of Child and Adolescent Psychiatry recommends:

• The urgent identification of and clinical intervention for children and youth at risk for suicide.
• Key components of a comprehensive, cross-sector approach to reduce rates of suicide should include:
  • Improved education of health care providers, educators and the general public about risk factors for suicide, as well as observable signs of risk for suicidal thoughts and behaviors;
  • Screening for suicide risk across physical and mental health care settings;
  • Greater utilization of evidence-based treatments of mental health conditions for affected individuals; and
  • Reduced access to firearms and other lethal means for at-risk individuals.

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The American Academy of Child and Adolescent Psychiatry promotes the healthy development of children, adolescents, and families through advocacy, education, and research. Child and adolescent psychiatrists are the leading physician authority on children’s mental health.

Approved by Council June 2019