Unmasking Suicide in Youths


Unmasking Suicide in Youths

a Psychiatrist.com Curated Collection

From this collection of 16 articles,* you’ll be able to

  • Identify clinical characteristics of young patients who are likely to attempt suicide
  • Spot the warning signs in specific behaviors
  • Determine if patients’ thought processes, and even their personalities, may put them at an elevated risk for suicide
  • Consider whether other medical or mental factors play a role in risk
  • Know what tools are helpful in diagnosing and preventing suicide

*Articles identified as CME may no longer be available for credit; please check expiration dates.

Introduction by Philippe Courtet, MD, PhD, Section Editor for JCP’s Focus on Suicide

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Lifetime prevalences of suicidal ideation and suicide attempts in youth are high, respectively around 20% and from 3% to 9% (WHO 2017), and suicide death accounts for 8.5% of all deaths among adolescents and young adults around the world (aged 15–29 years). In this age group, suicide is the second leading cause of death in the United States (2016 CDC WISQARS) and the third leading cause of death worldwide (WHO 2017). In several countries including the United States, the rate of suicide of the youngest has gradually increased since the turn of our century. Additionally, the decreasing age at onset of self-harm and increasing lethal methods indicate the need of targeted interventions in key transition stages for young people.

Suicidal thoughts and behaviors are underpinned by environmental risk factors that interact with psychological risk factors (eg, affective, cognitive, social processes) and biological features (eg, neurobiological, molecular, genetic factors). Notably, exposure to interpersonal violence (childhood maltreatment, bullying, and community violence) has been linked prospectively to suicide attempts and deaths. Experiencing early life adverse events may induce changes in gene expression through epigenetic mechanisms and may alter both brain structure and function, facilitating maladaptive behaviors. Deciphering this complexity may help to identify pharmacologic and environmental interventions to reverse these long-term consequences.

Mental and substance use disorders are strong contributors to all suicide, indicating the importance of their effective management as part of suicide prevention strategies. The use of antidepressant drugs in youth has been highly controversial in recent years, and the warnings have been accused of discouraging doctors from prescribing antidepressants when they were clinically indicated. Otherwise, promising news about psychosocial interventions for adolescent self-harm and the efficacy of school-based preventive interventions addressing suicidal behaviors underline the benefit of both indicated and universal suicide preventive intervention in young people. There is much work to be done to better understand suicidal thoughts and behaviors among youth and ultimately efficiently improve their prevention.

Noncompliance with the norm, at an age when construction of identity is in process and refers to others, may weaken the self-esteem and constitute an important suicidal actor in adolescents though. Bullying and discrimination (related to physical appearance, disability, or sexual orientation) that adolescents face may increase suicidal risk. The internet has become an important platform for information and communication about suicide among young people. While it may be harmful (cyberbullying, “Blue Whale Challenge”) in vulnerable youths, social media may also play a preventive role and help to identify young people at high risk for suicidal behavior. Individualized web-based tools, machine-learning algorithms, and mobile apps offer new avenues for suicide prevention, whereas methodologically robust research studies to evaluate their safety, efficacy, and effectiveness are promptly needed.

If you are considering suicide or you know someone who needs help, contact National Suicide Prevention Lifeline (USA): 1-800-273-(TALK) 8255

Collection Contents

Recognizing the Clinical Characteristics of Youths at Risk


Clinical Differences Between Suicidal and Nonsuicidal Depressed Children and Adolescents

J Clin Psychiatry 2005;66(4):492–498


Contributing Factors and Mental Health Outcomes of First Suicide Attempt During Childhood and Adolescence: Results From a Nationally Representative Study

J Clin Psychiatry 2017;78(6):e622–e630


Clinical Features of Depressed Children and Adolescents With Various Forms of Suicidality

J Clin Psychiatry 2006;67(9):1442–1450

Transition From Self-Harm to Suicide


A Longitudinal Study of Nonsuicidal Self-Injury in Offspring at High Risk for Mood Disorder

J Clin Psychiatry 2012;73(6):821–828

Inflammation and Suicidality


Inflammatory Markers and the Pathogenesis of Pediatric Depression and Suicide: A Systematic Review of the Literature

J Clin Psychiatry 2014;75(11):1242–1253

Sleep Disturbance and Suicidality


Objectively Assessed Sleep Variability as an Acute Warning Sign of Suicidal Ideation in a Longitudinal Evaluation of Young Adults at High Suicide Risk

J Clin Psychiatry 2017;78(6):e678–e687

Internet Addiction Among Adolescents Increases Suicidal Risk


Internet Addiction and Its Relationship With Suicidal Behaviors: A Meta-Analysis of Multinational Observational Studies

J Clin Psychiatry 2018;79(x):17r11761

Risk Factors During College


Characteristics and Risk Factors for Suicide and Deaths Among College Students: A 23-Year Serial Prevalence Study of Data From 8.2 Million Japanese College Students

J Clin Psychiatry 2017;78(4):e404–e412

Thought Patterns May Determine Level of Urgency


Cognitive Control Deficits Differentiate Adolescent Suicide Ideators From Attempters

J Clin Psychiatry 2017;78(6):e614–e621

Coping Strategies Play a Role


Responses to Depressed Mood and Suicide Attempt in Young Adults With a History of Childhood-Onset Mood Disorder**

J Clin Psychiatry 2009;70(5):644–652

Suicidality in First-Episode Psychoses


Predictors of Suicide Attempt in Early-Onset, First-Episode Psychoses: A Longitudinal 24-Month Follow-Up Study

J Clin Psychiatry 2013;74(1):59–66

Suicidality During Treatment for Depression


Suicidal Events in the Treatment for Adolescents With Depression Study (TADS)

J Clin Psychiatry 2009;70(5):741–747

Active Screening


Patient Health Questionnaire Depression Scale as a Suicide Screening Instrument in Depressed Primary Care Patients: A Cross-Sectional Study

Prim Care Companion CNS Disord 2011;13(1):e1–e6


A Risk Algorithm for the Persistence of Suicidal Thoughts and Behaviors During College

J Clin Psychiatry 2017;78(7):e828–e836

Prevention Strategies


Student Evaluation of the Yellow Ribbon Suicide Prevention Program in Midwest Schools**

Prim Care Companion CNS Disord 2016;18(3):doi:10.4088/PCC.15m01852


Guns and Suicide: Are They Related?

Prim Care Companion CNS Disord 2017;19(6):17br02116


**Although this CME activity is expired, the posttest and answers are provided for your benefit.

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Further Reading

The following articles, even though outside the specific scope of this collection, provide further information about diagnosing and preventing suicide and offer guidance on treating those bereaved by the loss of a loved who may die by suicide.

Consensus Statement

Assessment of Suicidal Ideation and Behavior: Report of the International Society for CNS Clinical Trials and Methodology Consensus Meeting

Free Article

J Clin Psychiatry 2017;78(6):e638–e647

Screening Tool Within the Electronic Medical Record

Electronic Clinical Decision Support for Management of Depression in Primary Care: A Prospective Cohort Study

Free HTML with registration

Prim Care Companion CNS Disord 2012;14(1):doi:10.4088/PCC.11m01191

Helping Those Left Behind

Treatment of Complicated Grief in Survivors of Suicide Loss: A HEAL Report

Free with subscription

J Clin Psychiatry 2018;79(2):17m11592

If you are considering suicide or you know someone who needs help,
contact National Suicide Prevention Lifeline (USA): 1-800-273-(TALK) 8255


Psychiatrist.com Curated Collection


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