From the Journals

Suicide thoughts, attempts in adolescence correlate with mental health symptoms

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Have resources ready to facilitate suicide screening

Interestingly, this study by Orri et al. found that there was not a peak in suicide attempts in mid-adolescence; instead, rates of attempts were stable throughout adolescence and serious suicidal ideation actually increased with age. This was an unexpected finding for me, and something I will be more mindful about in my clinical practice when seeing older teens and young adults. Additionally, all mental health problems – not just depression – evaluated in univariate analyses in the study were associated with suicidal thoughts and attempts. On multivariable analysis that accounted for the impact of the effect of comorbid mental health symptoms, depressive symptoms had the highest and most consistent correlation to suicidal thoughts, and conduct symptoms were associated with an increase in suicide attempts. The authors conclude that youth with mental health symptoms – not just those who meet diagnostic criteria – should be assessed for suicide risk.

Dr. Kelly Curran, assistant professor of pediatrics at the University of Oklahoma Health Sciences Center, Oklahoma City

Dr. Kelly Curran

I think this recommendation is important for pediatricians to include in care for teens. When we think about all of the topics we screen and counsel about – healthy diet and exercise, dental health, injury prevention, and screen time, to name just a few – it can seem overwhelming to “add one more thing” when many clinicians already feel stretched for time. Others may shy away because of their own discomfort or perceptions of patient or family distress around the topic or avoid screening because they feel they lack the skills or resources to help patients with suicidal thoughts. However, mental health problems – including suicide – are incredibly common and cause significant morbidity and mortality. Screening for suicide is important – remember, too, that you can save a life and decrease the second leading cause of death in teens!

In my subspecialty practice, we screen every new patient for suicide regardless of the reason for their visit and more often for those with mental health symptoms. I know this may seem onerous, but screening and counseling typically take under 5 minutes – and in many instances around 1-2 minutes. Having ready-to-go resources including mental health professionals to refer to, screening algorithms (such as protocols published in MedEdPORTAL or Family Practice Management), and suicide prevention resources for patients and family for those who screen positive can help expedite this process. I think these recommendations can be adapted with relative ease into any visit for a teen or young adult who is presenting with a mental health complaint.

Kelly A. Curran, MD, is an assistant professor of pediatrics at the University of Oklahoma in Oklahoma City. She is a member of the Pediatric News editorial advisory board. Dr. Curran said she had no relevant financial disclosures.



About one in five adolescents has thought about suicide, about 10% have experienced serious suicidal ideation, and 7% have attempted suicide by age 20 years, according to a longitudinal study of Canadian adolescents published online in Pediatrics.

A doctor taking notes with a young male patient AlexRaths/Thinkstock

In multivariable analyses, depression and anxiety were independently associated with passive and serious suicidal ideation at some ages, but none of the externalizing problems were significantly associated with passive or serious suicidal ideation. However, “both depressive and conduct symptoms [were] independently associated with suicidal risk,” the researchers found. Most adolescents with suicidal ideation or suicide attempt met criteria for at least one mental health problem.

“These findings suggest that suicide risk should be systematically assessed in adolescents who present with mental health symptoms and not solely in adolescents with clinically diagnosed mental disorders,” said Massimiliano Orri, PhD, and colleagues. Dr. Orri is affiliated with the McGill Group for Suicide Studies, Douglas Mental Health University Institute, Montreal, and the University of Bordeaux (France).

To document the prevalence of passive or serious suicidal ideation and suicide attempt from ages 13-20 years and examine correlations with mental health symptoms, Dr. Orri and colleagues analyzed data from 1,618 participants in the Quebec Longitudinal Study of Child Development. The population-based study follows individuals born in 1997 and 1998 in Quebec. Participants answered questions about suicidal ideation or suicide attempt in the past year at ages 13, 15, 17, or 20 years (“Did you ever think about suicide?” “Did you ever seriously think of attempting suicide?” and “How many times did you attempt suicide?”). The researchers assessed symptoms of mental health problems using self-report questionnaires.

Lifetime prevalence of suicide-related outcomes was higher for female participants than for male participants. The prevalence of passive suicidal ideation was 28% in females versus 15% in males. The prevalence of serious suicidal ideation was 12% in females versus 8% in males. The prevalence of suicide attempt was 9% in females versus 4% in males. “Sex differences in suicidal ideation and suicide attempt might be attributed to various factors, such as mental health (e.g., higher prevalence of depression in female participants) or social stigma (e.g., greater stigma around suicide in male than in female participants),” the authors wrote.

In the entire cohort, the prevalence of passive suicidal ideation increased from 12% at 13 years to 18% at 17 years. The prevalence of serious suicidal ideation increased from 3% at 13 years to 10% at 20 years. The prevalence of suicide attempt was approximately 4% at each age.

“Although having a major depressive episode is a well-known risk factor of suicidal ideation and suicide attempt, our study adds to the general body of knowledge by showing associations with suicide-related outcomes across the full spectrum of depressive symptoms,” Dr. Orri and colleagues wrote. “This suggests that youth who present with depressive symptoms (and not solely those who are clinically depressed) may be more likely to experience suicidal ideation or attempt suicide.”

The estimated rates of serious suicidal ideation and attempted suicide by age 20 years are consistent with previous U.S. and Canadian surveys. Sample attrition, the use of different questionnaires in early and late adolescence, and the lack of information about substance use and psychotic symptoms are among the study’s limitations.

Six of the authors were supported by grants from a variety of Canadian and European agencies and the American Foundation for Suicide Prevention. All of the authors said they had no relevant financial disclosures.

SOURCE: Orri M et al. Pediatrics. 2020 Jun 8. doi: 10.1542/peds.2019-3823.

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