This is Part 1 of a 2-part review of suicidal behaviour in children and adolescents. Part 1 explores the phenomenology and epidemiology of suicide in children and adolescents.
Method
Systematic review of the literature since 1966. Behaviours included within this spectrum are discussed and differentiated. The literature regarding the impact of demographic, social, and psychological risk factors is summarized.
Results and Conclusions
Suicide rates in youth are declining, but the reasons are speculative. Suicidal behaviour comprises a spectrum with differing frequencies and risk factors. While some risk factors are fixed, such as age and family history, others, such as psychiatric illness and stressors, may be amenable to intervention.
ShafferD, PfefferCR, BernetW, . Practice parameter for the assessment and treatment of children and adolescents with suicidal behaviour. J Am Acad Child Adolesc Psychiatry. 2001;40:(7 Suppl)24S–51S.
2.
BrentDA.Depression and suicide in children and adolescents. Pediatr Rev. 1993;14:380 -388.
3.
HarringtonR, PicklesA, AglanA, . Early adult outcomes of adolescents who deliberately poisoned themselves. J Am Acad Child Adolesc Psychiatry. 2005;45:337–345.
Public Health Agency of Canada. Measuring up: a health surveillance update on Canadian children and youth. Ottawa (ON): Minister of Health; 1999. Available from: http://www.phac-aspc.gc.ca/publicat/meas-haut/mu_y_e.html (accessed April 2007).
6.
AndersonRN.Deaths: leading causes for 2000. Natl Vital Stat Rep. 2002;50:1–85.
7.
JeanneretO.A tentative epidemiologic approach to suicide prevention in adolescence. J Adolesc Health. 1992;13:409–414.
8.
MethaA, WeberB, WebbLD.Youth suicide prevention: a survey and analysis of policies and efforts in the 50 states. Suicide Life Threat Behav. 1998;28:150–164.
9.
GouldMS, GreenbergT, VeltingDM, . Youth suicide risk and preventive interventions: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry. 2003;42:386–405.
BrentDA, PerperJA, AllmanCJ, . The presence and accessibility of firearms in the homes of adolescent suicides: a case-control study. JAMA. 1991;266:2989–2995.
12.
OlfsonM, MarcusSC, PincusHA, . Antidepressant prescribing practices of outpatient psychiatrists. Arch Gen Psychiatry. 1998;55:310–316.
CutrightP, FernquistRM.Firearms and suicide: the American experience, 1926-1996. Death Stud. 2000;24:705–719.
18.
SimonGE, Von KorffM.Reevaluation of secular trends in depression rates. Am J Epidemiol. 1992;135:1411–1422.
19.
MurphyJM, LairdNM, MonsonRR, . A 40 year perspective on the prevalence of depression. The Stirling County Study. Arch Gen Psychiatry. 2000;57:207–215.
20.
KesslerRC, McGonagleKA, ZhaoS, . Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994;51:8–19.
21.
JoycePR.Improvements in the recognition and treatment of depression and decreasing suicide rates. N Z Med J. 2001;114:535–536.
HazellP, O'ConnellD, HeathcoteD, . Tricyclic drugs for depression in children and adolescents. Cochrane Database Syst Rev.2000;(3):CD002317.
24.
OlfsonM, MarcusSC, WeissmanMM, . National trends in the use of psychotropic medications by children. J Am Acad Child Adolesc Psychiatry. 2002;41:514–521.
25.
IsacssonG.Suicide prevention-a medical breakthrough? Acta Psychiatr Scand. 2000;102113–117.
26.
LudwigJ, MarcotteDE.Anti-depressants, suicide, and drug regulation. J Policy Anal Manage. 2005;24:249–272.
27.
GibbonsRD, HurK, BhaumikDK, . The relationship between antidepressant prescription rates and rate of early adolescent suicide. Am J Psychiatry. 2006;163;1898–1904.
28.
JickH, KayeJA, JickSS.Antidepressants and the risk of suicidal behaviors. JAMA. 2004;292:338–343.
29.
Medicines and Healthcare products Regulatory Agency. Safety review of antidepressants used by children completed. [Use of selective serotonin reuptake inhibitors (SSRIs) in children and adolescent with major depressive disorder (MDD)-only fluoxetine (Prozac) shown to have a favourable balance of risks and benefits for the treatment of MDD in the under 18s.] 10 December 2003. [cited 2004 Mar 14]. Available from: http://www.mhra.gov.uk/home/idcplg?IdcService=SS_GET_PAGE&useSecondary=true&ssDocName=CON002045&ssTargetNodeId=389 (accessed April 2007).
30.
US Food and Drug Administration. FDA Public Health Advisory. Suicidality in children and adolescents being treated with antidepressant medications. 15 October 2004 [cited 2005 Mar 5]. Available from: http://www.fda.gov/cder/drug/antidepressants/SSRIPHA200410.htm.
BaillyD.[Safety of selective serotonin reuptake inhibitor antidepressants in children and adolescents]. Presse Med. 2006;35:(10 Pt 2)1507–1515.
33.
JureidiniJN, DoeckeCJ, MansfieldPR, . Efficacy and safety of antidepressants for children and adolescents. BMJ. 2004;328:879–883.
34.
WhittingtonCJ, KendallT, FonagyP, . Selective serotonin reuptake inhibitors in childhood depression: systematic review of published versus unpublished data. Lancet. 2004;363:1341–1345.
35.
AichhornAW, GeretseggerC.Safety and efficacy of selective serotonin reuptake inhibitors in the treatment of children and adolescents compared to adults. Neuropsychiatrie. 2005;19:34–39.
36.
BridgeJA, SalaryCB, BirmaherB, . The risks and benefits of antidepressant treatment for youth depression. Ann Med. 2005;37:404–412.
37.
EmslieGJ, WagnerKD, KutcherS, . Paroxetine treatment in children and adolescents with major depressive disorder: a randomized, multicenter, double-blind, placebo-controlled trial. J Am Acad Child Adolesc Psychiatry. 2006;45:709–719.
38.
ApterA, LipschitzA, FongR, . Evaluation of suicidal thoughts and behaviors in children and adolescents taking paroxetine. J Child Adolesc Psychopharmacol. 2006;16:(1-2)77–90.
39.
BerardR, FongR, CarpenterDJ, . An international, multicenter, placebo-controlled trial of paroxetine in adolescents with major depressive disorder. J Child Adolesc Psychopharmacol. 2006;16:(1-2)59–75.
40.
AursnesI, TveteIF, GaasemyrJ, . Suicide attempts in clinical trials with paroxetine randomised against placebo. BMC Med. 2005;3:14.
41.
von KnorringAL, OlssonGI, ThomsenPH, . A randomized, double-blind, placebo-controlled study of citalopram in adolescents with major depressive disorder. J Clin Psychopharmacol. 2006;26:311–315.
42.
MarchJS, KleeBJ, KremerCME.Treatment benefit and the risk of suicidality in multicenter, randomized, controlled trials of sertraline in children and adolescents. J Child Adolesc Psychopharmacol. 2006;16:(1-2)91–102.
43.
NilssonM, JoliatMJ, MinerCM, . Safety of subchronic treatment with fluoxetine for major depressive disorder in children and adolescents. J Child Adolesc Psychopharmacol. 2004;14:412–417.
44.
WagnerKD, JonasJ, FindlingRL.. A double-blind, randomized, placebo-controlled trial of escitalopram in the treatment of pediatric depression. J Am Acad Child Adolesc Psychiatry. 2006;45:280–288.
45.
CourtneyDB.Selective serotonin reuptake inhibitor and venlafaxine use in children and adolescents with major depressive disorder: a systematic review of published randomized controlled trials. Can J Psychiatry. 2004;49:557–563.
46.
MosholderAD, PamerC.Postmarketing surveillance of suicidal adverse events with pediatric use of antidepressants. J Child Adolesc Psychopharmacol. 2006;16:(1-2)33–36.
47.
HammadTA, LaughrenT, RacoosinJ.Suicidality in pediatric patients treated with antidepressant drugs. Arch Gen Psychiatry. 2006;63:332–339.
48.
SondergL, KvistK, AndersenPK, . Do antidepressants precipitate youth suicide?: a nationwide pharmacoepidemiological study. Eur Child Adolesc Psychiatry. 2006;15:232–240.
49.
WohlfarthTD, van ZwietenB, LekkerkerkerFJ, . Antidepressants use in children and adolescents and the risk of suicide. Eur Neuropsychopharmacol. 2006;16:79–83.
50.
AndradeNN, HishinumaES, McDermottJF, . The National Center on Indigenous Hawaiian Behavioral Health study of prevalence of psychiatric disorders in native Hawaiian adolescents. J Am Acad Child Adolesc Psychiatry. 2006;45:26–36.
51.
RihmerZ, AkiskalH.Do antidepressants t(h)reat(en) depressives? Toward a clinically judicious formulation of the antidepressant-suicidality FDA advisory in light of declining national suicide statistics from many countries. J Affect Disord. 2006;94:(1-3)3–13.
52.
SharpSC, HellingsJA.Efficacy and safety of selective serotonin reuptake inhibitors in the treatment of depression in children and adolescents: practitioner review. Clin Drug Investig. 2006;26:247–255.
53.
VasaR A, CarlinoAR, PineDS.Pharmacotherapy of depressed children and adolescents: current issues and potential directions. Biol Psychiatry. 2006;59:1021–1028.
54.
CheungAH, EmslieGJ, MayesTL.Review of the efficacy and safety of antidepressants in youth depression. J Child Psychol Psychiatry. 2005;46:735–754.
55.
BridgeJA, BarbeRP, BirmaherB, . Emergent suicidality in a clinical psychotherapy trial for adolescent depression. Am J Psychiatry. 2005;162:2173–2175.
56.
Lothen-KlineC, HowardDE, HamburgerEK, . Truth and consequences: ethics, confidentiality, and disclosure in adolescent longitudinal prevention research. J Adolesc Health. 2003;33:385–394.
57.
ClaassenCA, LarkinGL.Occult suicidality in an emergency department population. Br J Psychiatry. 2005;186:352–353.
58.
PfefferC, LipkinsCR, PlutchikR, . Normal children at risk for suicidal behaviour: a two-year follow up. J Am Acad Child Adolesc Psychiatry. 1988;27:34–41.
59.
JoffeRT, OffordDR, BoyleMH.Ontario Child Health Study: suicidal behavior in youth aged 12-16 years. Am J Psychiatry. 1988;145(11):1420–1423.
60.
WhitlockJ, EckenrodeJ, SilvermanD.Self-injurious behaviors in a college population. Pediatrics. 2006;117:1939–1948.
61.
PfefferCR, KlermanGL, HurtSW, . Suicidal children grow up: rates and psychosocial risk factors for suicide attempts during follow-up. J Am Acad Child Adolesc Psychiatry. 1993;32:106–113.
62.
HawtonK, FaggJ.Trends in deliberate self-poisoning and self-injury in Oxford, 1976-1990. BMJ. 1992;304:1409–1411.
63.
HurryJ, StoreyP.Deliberate self-harm in young people: the hospital response. Final report to the Department of Health. London (GB): HMSO;1998.
64.
KerfootM.Youth suicide. In: AggletonP, HurryH, WarwickI.Young people and mental health. London (GB): Wiley;2000.
65.
HobermanH, GarfinkelB.Completed suicide in children and adolescents. J Am Acad Child Adolesc Psychiatry. 1988;27:689–695.
66.
HurryJ.Deliberate self-harm in children and adolescents. Int Rev Psychiatry. 2000;12:31–36.
67.
DiekstraR, KeinhorstC, De WildeE.Suicide and suicidal behaviour among adolescents. In: RutterM, SmithD.Psychosocial disorders in young people: time trends and their causes. Chichester (GB): Wiley;1995.
68.
KerfootM, McHughB.The outcome of childhood suicidal behaviour. Acta Paedopsychiatr. 1992;55:141–145.
69.
AndrewsJA, LewinsohnPM.Suicidal attempts among older adolescents: prevalence and co-occurrence with psychiatric disorders. J Am Acad Child Adolesc Psychiatry. 1992;31:655–662.
70.
DiekstraR.Suicidal behavior and depressive disorders in adolescents and young adults. Neuropsychobiology. 1989;22:194–207.
71.
BurnsJ, DudleyM, HazelP, . Clinical management of deliberate self-harm in young people: the need for evidence-based approaches to reduce repetition. Aust N Z J Psychiatry. 2005;39:121–128.
72.
BeckAT.Beyond belief: a theory of modes, personality, and psychopathology. In: SalkovskisPM.Frontiers of cognitive therapy. New York (NY): Guilford;1996. p 1–25.
73.
BeckAT, SchuylerD, HermanI.Development of suicidal intent scales. In: BeckAT, RsnikHLP, LettieriDJ.The prediction of suicide. Bowie (MD): Charles Press;1974. p 45–56.
AndrusJK, FlemingDW, HeumannMA, . Surveillance of attempted suicide among adolescents in Oregon, 1988. Am J Public Health.1991;81:1067–1069.
76.
VelezCN, CohenP.Suicidal behavior and ideation in a community sample of children: maternal and youth reports. J Am Acad Child Adolesc Psychiatry. 1988;27:349–356.
77.
BrentDA, PerperJA, MoritzG, . Psychiatric risk factors for adolescent suicide: a case-control study. J Am Acad Child Adolesc Psychiatry. 1993;32:521–529.
78.
ShafferD, GouldMS, FisherP, . Psychiatric diagnosis in child and adolescent suicide. Arch Gen Psychiatry. 1996;53:339–348.
79.
KesslerRC, BorgesG, WaltersEE.Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Study. Arch Gen Psychiatry. 1999;56:617–626.
80.
LewinsohnPM, RohdeP, SeeleyJR, . Gender differences in suicide attempts from adolescence to young adulthood. J Am Acad Child Adolesc Psychiatry. 2001;40:427–434.
81.
International Association for Suicide Prevention (IASP) Executive Committee. IASP guidelines for suicide prevention. Crisis. 1999;20:155–163.
82.
BeautraisAL.Suicide and serious suicide attempts in youth: a multiple-group comparison study. Am J Psychiatry. 2003;160:1093–1099.
83.
BeautraisAL.Methods of youth suicide in New Zealand: trends and implications for prevention. Aust N Z Y Psychiatry. 2000;34:413–419.
84.
PhillipsMR, LiX, ZhangY.Suicide rates in China, 1995-1999. Lancet. 2002;359:835–840.
BorowskyIW, ResnickMD, IrelandM, . Suicide attempts among American Indian and Alaska Native youth: risk and protective factors. Arch Pediatr Adolesc Med. 1999;153:573–580.
87.
ShiangJ, BlinnR, BongarB, . Suicide in San Francisco, CA: a comparison of Caucasian and Asian groups, 1987-1994. Suicide Life Threat Behav. 1997;27:80–91.
88.
WallaceJD, CalhounAD, PowellKE, ; National Centre for Injury Prevention and Control. Homicide and Suicide Among Native Americans, 1979-992. Violence Surveillance Series, No. 2. Atlanta (GA): Centers for Disease Control and Prevention; 1996.
89.
MiddlebrookDL, Le MasterPL, BealsJ, . Suicide prevention in American Indian and Alaska Native communities: a critical review of programs. Suicide Life Threat Behav. 2001;31:(Suppl)132–149.
90.
GibbsJT.African-American suicide: a cultural paradox. Suicide Life Threat Behav. 1997;27:68–79.
91.
ShafferD, GouldM, HicksRC.Worsening suicide rate in black teenagers. Am J Psychiatry. 1994;151(12):1810–1812.
92.
BeautraisAL.Child and young adolescent suicide in New Zealand. Aust N Z J Psychiatry. 2001;35(5):647–653.
93.
BrentDA, BaugherM, BridgeJ, . Age- and sex-related risk factors for adolescent suicide. J Am Acad Child Adolesc Psychiatry. 1999;38:1497–1505.
94.
GroholtB, EkebergO, WichstromL, . Suicide among children and younger and older adolescents in Norway: a comparative study. J Am Acad Child Adolesc Psychiatry. 1998;37:473–481.
95.
MarttunenMJ, AroHM, HenrikssonMM, . Mental disorders in adolescent suicide. Arch Gen Psychiatry. 1991;48:834–839.
96.
ShafferD, CraftL.Methods of adolescent suicide prevention. J. Clin Psychiatry. 1999;60:(Suppl 2)70–74; discussion 75-76, 113-116.
97.
BrentDA, PerperJ, MoritzG, . Suicide in adolescent with no apparent psychopathology. J Am Acad Child Adolesc Psychiatry. 1993;32:494–500.
98.
EvansE, HawtonK, RodhamK.Factors associated with suicidal phenomena in adolescents: a systematic review of population-based studies. Clin Psychol Rev. 2004;24:957–979.
99.
CartaMG, AltamuraAC, HardoyMC. Is recurrent brief depression an expression of mood spectrum disorders in young people? Results of a large community sample. Eur Arch Psychiatry Clin Neurosci. 2003;253:149–153.
100.
SimonNM, OttoMW, Wisniewski StephenR, . Anxiety disorder comorbidity in bipolar disorder patients: data from the first 500 participants in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Am J Psychiatry.2004;161):2222–2229.
101.
BrentDA, PerperJA, GoldsteinCE, . Risk factors for adolescent suicide: a comparison of adolescent suicide victims with suicidal inpatients. Arch Gen Psychiatry. 1988;45(6):581–588.
102.
RichCL, YoungJG, FowlerRC, . Guns and suicide: possible effects of some specific legislation. Am J Psychiatry. 1990;147:342–346.
103.
RunesonB.Mental disorder in youth suicide: DSM-III-R Axes I and II. Acta Psychiatr Scand. 1989;79:490–497.
104.
PowerPJR, BellRJ, MillsR, . Suicide prevention in first episode psychosis: the development of a randomised controlled trial of cognitive therapy for acutely suicidal patients with early psychosis. Aust N Z J Psychiatry. 2003;37:414–420.
105.
CoyleJT, PineDS, CharneyDS, . Depression and bipolar support alliance consensus statement on the unmet needs in diagnosis and treatment of mood disorders in children and adolescents. J Am Acad Child Adolesc Psychiatry. 2003;42:1494–1503.
106.
ReyJM, MartinA, KrabmanP.Is the party over? Cannabis and juvenile psychiatric disorder: the past 10 years. J Am Acad Child Adolesc Psychiatry. 2004;43:1194–1205.
107.
PirkolaS P, SuominenK, IsometsaET.Suicide in alcohol-dependent individuals: epidemiology and management. CNS Drugs. 2004;18:423–436.
108.
PowerPJ R, BellRJ, MillsR, . Suicide prevention in first episode psychosis: the development of a randomised controlled trial of cognitive therapy for acutely suicidal patients with early psychosis. Aust N Z J Psychiatry. 2003;37:414–420.
109.
KotilaL, LonnqvistJ.Suicide and violent death among adolescent suicide attempters. Acta Psychiatr Scand. 1989;79:453–459.
110.
GouldMS, KingR, GreenwaldS, . Psychopathology associated with suicidal ideation and attempts among children and adolescents. J Am Acad Child Adolesc Psychiatry. 1998;37:915–923.
111.
KandelDB.Substance use, depressive mood, and suicidal ideation in adolescence and young adulthood. In: StiffmanAR, FeldmanRA.Advancement in adolescent mental health. Greenwich (CT): JAI Press;1988. p 127–142.
112.
GiaconiaRM, ReinherzHZ, SilvermanAB, . Traumas and posttraumatic stress disorder in a community population of older adolescents. J Am Acad Child Adolesc Psychiatry. 1995;34:1369–1380.
113.
MazzaJJ.The relationship between posttraumatic stress symptomatology and suicidal behaviour in school-based adolescents. Suicide Life Threat Behav. 2000;30:91–103.
114.
WunderlichU, BronischT, WittchenHU.Comorbidity patterns in adolescents and young adults with suicide attempts. Eur Arch Psychiatry Clin Neurosci. 1998;248:87–95.
115.
GouldMS.FisherP, ParidesM, . Psychosocial risk factors of child and adolescent completed suicide. Arch Gen Psychiatry. 1996;53:1155–1162.
116.
PilowskyDJ, WuL, AnthonyJC.Panic attacks and suicide attempts in mid-adolescence. Am J Psychiatry. 1999;156:1545–1549.
117.
BorowskyI, ResnickMD, IrelandM, . Suicide attempts among American Indian and Alaska native youth. Arch Pediatr Adolesc Med. 1999;153:573–80.
118.
AsarnowJR, CarlsonG, GuthrieD.Coping strategies, self perceptions, hopelessness and perceived family environments in depressed and suicidal children. J Consult Clin Psychol. 1987;55:361–366.
119.
KienhorstCWM, de WildeEJ, DiekstraRFW, . Differences between adolescent suicide attempters and depressed adolescents. Acta Psychiatr Scand. 1992;85:222–228.
120.
Mac LeaveyBC, DalyRJ, MurrayCM, . Interpersonal problem-solving deficits in self-poisoning patients. Suicide Life Threat Behav. 1987;17:33–49.
121.
NeuringerC.Psychological assessment of suicidal risk. Springfield (IL): Charles C. Thomas; 1974.
Rotheram-BorusMJ, TrautmanPD.DopkinsSC, . Cognitive style and pleasant activities among female adolescent suicide attempters. J Consult Clin Psychol. 1990;58:554–561.
124.
SpiritoA, WilliamsCA, StarkLJ, . The Hopelessness Scale for Children: psychometric properties with normal and emotionally disturbed adolescents. J Abnorm Child Psychol. 1988;16:445–458.
125.
TopolP, ReznikoffM.Perceived peer and family relationships, hopelessness and locus of control as factors in adolescent suicide attempts. Suicide Life Threat Behav. 1982;12:141–150.
126.
BeautraisAL, JoycePR, MulderRT.Personality traits and cognitive styles as risk factors for serious suicide attempts among young people. Suicide Life Threat Behav. 1999;29:37–47.
127.
Cole Hopelessness DA., social desirability, depression, and parasuicide in two college student samples. J Consult Clin Psychol.1988;56:131–136.
128.
Howard-PitneyB, La FromboiseTD.BasilM, . Psychological and social indicators of suicide ideation and suicide attempts in Zuni adolescents. J Consult Clin Psychol. 1992;60:473–476.
ReifmanA, WindleM.Adolescent suicidal behaviors as a function of depression, hopelessness, alcohol use, and social support: a longitudinal investigation. Am J Community Psychol. 1995;23:329–354.
131.
Rotheram-BorusMJ, Trautman Hopelessness PD., depression, and suicidal intent among adolescent suicide attempters. J Am Acad Child Adolesc Psychiatry.1988;27:700–704.
132.
ApterA, PlutchikR, van PraagAnxietyHM., impulsivity and depressed mood in relation to suicidal and violent behavior. Acta Psychiatr Scand. 1993;87:1–5.
133.
BrentDA, JohnsonB, BartleS, . Personality disorder, tendency to impulsive violence, and suicidal behavior in adolescents. J Am Acad Child Adolesc Psychiatry. 1993;32:69–75.
134.
BrentDA, JohnsonBA, PerperJ, . Personality disorder, personality traits, impulsive violence, and completed suicide in adolescents. J Am Acad Child Adolesc Psychiatry. 1994;33:1080–1086.
135.
McKeownRE, GarrisonCZ.CuffeSP, . Incidence and predictors of suicidal behaviours in a longitudinal sample of young adolescents. J Am Acad Child Adolesc Psychiatry. 1998;37:612–619.
136.
PfefferCR, NewcornJ, KaplanG, . Suicidal behavior in adolescent suicidal inpatients. J Am Acad Child Adolesc Psychiatry. 1988;27:357–361.
137.
SouranderA, HelstelaL, HaavistoA, . Suicidal thoughts and attempts among adolescents: a longitudinal 8-year follow-up study. J Affect Disord. 2001;63:(1-3)59–66.
138.
LessardJC, MorettiMM.Suicidal ideation in an adolescent clinical sample: attachment patterns and clinical implications. J Adolesc. 1998;21:383–395.
139.
BrownJ, CohenP, JohnsonJG, . Childhood abuse and neglect: specificity of effects on adolescent and young adult depression and suicidality. J Am Acad Child Adolesc Psychiatry. 1999;38:1490–1496.
140.
CatallozziM, PletcherJR, SchwarzDF.Prevention of suicide in adolescents. Curr Opin Pediatr. 2001;13:417–422.
141.
FergussonDM, HorwoodLJ, LynskeyMT.Childhood sexual abuse and psychiatric disorder in young adulthood. II: psychiatric outcomes of childhood sexual abuse. J Am Acad Child Adolesc Psychiatry. 1996;35:1365–1374.
142.
JohnsonJG, CohenP, GouldMS, . Childhood adversities, interpersonal difficulties, and risk for suicide attempts during late adolescence and early adulthood. Arch Gen Psychiatry. 2002;59:741–749.
143.
MolnarBE, ShadeSB, KralAH, . Suicidal behavior and sexual/physical abuse among street youth. Child Abuse Negl. 1998;22:213–222.
144.
SilvermanAB, ReinherzHZ, GiaconiaRM.The long-term sequelae of child and adolescent abuse: a longitudinal community study. Child Abuse Negl. 1996;20:709–723.
145.
StathamDJ, HeathAC, MaddenPA, . Suicidal behaviour: an epidemiological and genetic study. Psychol Med. 1998;28:839–855.
146.
DeykinEY, AlpertJJ, McNamaraJJ.A pilot study of the effect of exposure to child abuse or neglect on adolescent suicidal behaviour. Am J Psychiatry. 1985;142:1299–1303.
147.
KaplanSJ, PelcovitzD, SalzingerS, . Adolescent physical abuse and suicide attempts. J Am Acad Child Adolesc Psychiatry. 1997;36:799–808.
148.
ShafferD, WilcoxH, LucasC, . The development of a screening instrument for teens at risk for suicide. Poster presented at the 1996 meeting of the American Academy of Child and Adolescent Psychiatry (AACAP); 1996; New York. In: AACAP. Practice parameter for the assessment and treatment of children and adolescents with suicidal behaviour. J Am Acad Child Adolesc Psychiatry. 2001;40:(7 Suppl)24S–51S.
149.
ChoquetM, Darves-BornozJM, LedouxR, . Self-reported health and behavioral problems among adolescent victims of rape in France: results of a cross-sectional survey. Child Abuse Negl. 1997;21:823–832.
150.
GutierrezP, KingCA, GhaziuddinN.Adolescent attitudes about death in relation to suicidality. Suicide Life Threat Behav. 1996;26:8–18.
151.
OverholserJ, HemstreetA, SpiritoA, . Suicide awareness programs in the schools: effects of gender and personal experience. J Am Acad Child Adolesc Psychiatry. 1989;28:925–930.
152.
AgerboE, NordentoftM, Mortensen Familial PB., psychiatric, and socioeconomic risk factors for suicide in young people: nested case control study. BMJ.2002;325:74.
153.
McGuffinP, MarusicA, FarmerA.What can psychiatric genetics offer suicidology? Crisis. 2001;22:61–65.
154.
BrentDA, PerperJA, MoritzG, . Familial risk factors for adolescent suicide: a case-control study. Acta Psychiatr Scand. 1994;89:52–58.
155.
FergussonDM, LynskeyM.Childhood circumstances, adolescent adjustment, and suicide attempts in a New Zealand birth cohort. J Am Acad Child Adolesc Psychiatry. 1995;34:612–622.
156.
KashaniJH, GoddardP, ReidJC.Correlates of suicidal ideation in a community sample of children and adolescents. J Am Acad Child Adolesc Psychiatry. 1989;28:912–917.
157.
KerfootM, DyerE, HarringtonV, . Correlates and short-term course of self-poisoning in adolescents. Br J Psychiatry. 1996;168:38–42.
158.
BeautraisAL, JoycePR, MulderRT.Risk factors for serious suicide attempts among youths aged 13 through 24 years. J Am Acad Child Adolesc Psychiatry. 1996;35:1174–1182.
159.
FergussonDM, WoodwardLJ, HorwoodLJ.Risk factors and life processes associated with the onset of suicidal behaviour during adolescence and early adulthood. Psychol Med. 2000;30:23–39.
160.
LewinsohnPM, RohdeP, SeeleyJ.Psychosocial characteristics of adolescents with a history of suicide attempt. J Am Acad Child Adolesc Psychiatry. 1993;32:60–68.
161.
TousignantM, BastienMF, HamelS.Suicidal attempts and ideations among adolescents and young adults: the contribution of the father's and mother's care and of parental separation. Soc Psychiatry Psychiatr Epidemiol. 1993;28:256–261.
162.
Hollis Depression C., family environment, and adolescent suicidal behaviour. J Am Acad Child Adolesc Psychiatry.1996;35:622–630.
163.
SauvolaA, RasanenPK, JoukamaaMI, . Mortality of young adults in relation to single-parent family background: a prospective study of the northern Finland 1966 birth cohort. Eur J Public Health. 2001;11:284–286.
164.
de WildeEJ, KienhorstIC, DiekstraRF, . The relationship between adolescent suicidal behaviour and life events in childhood and adolescence. Am J Psychiatry. 1992;149:45–51.
165.
HawtonK.Suicide and attempted suicide among children and adolescents. Newbury Park (CA): Sage;1986.
166.
BrentDA, PerperJA, MoritzG, . Stressful life events, psychopathology and adolescent suicide: a case control study. Suicide Life Threat Behav. 1993;23:179–187.
167.
RichCL, FowlerRC, FogartyLA, . San Diego Suicide Study, III: relationships between diagnoses and stressors. Arch Gen Psychiatry. 1988;45:589–592.
168.
RunesonB.Psychoactive substance use disorder in youth suicide. Alcohol Alcohol. 1990;25:561–568.
169.
BeautraisAL, JoycePR, MulderRT.Precipitating factors and life events in serious suicide attempts among youths aged 13 though 24 years. J Am Acad Child Adolesc Psychiatry. 1997;36:1543–1551.
170.
LewinsohnPM, RohdeP, SeeleyJR.Adolescent suicidal ideation and attempts: Prevalence, risk factors and clinical implications. Clin Psychol Sci Pract. 1996;3:25–26.
171.
BrentD, PerperJ, MoritzC, . Suicide in affectively ill adolescents: a case control study. J Affect Disord. 1994;31:193–202.
172.
DaleyAJ, CopelandRJ, WrightNP, . Exercise therapy as a treatment for psychopathologic conditions in obese and morbidly obese adolescents: a randomized, controlled trial. Pediatrics. 2006;118:2126–2134.
173.
HaarasiltaL, MarttunenM, KaprioJ, . Major depressive episode and physical health in adolescents and young adults: results from a population-based interview survey. Eur J Public Health. 2005;15:489–93.
174.
RafiroiuC, SargentRG, Parra-MedinaD, . Covariations of adolescent weight-control, health-risk and health-promoting behaviors. Am J Health Behav. 2003;27:3–14.
175.
PennJV, EspositoCL, SchaefferLE, . Suicide attempts and self-mutilative behavior in a juvenile correctional facility. J Am Acad Child Adolesc Psychiatry. 2003;42:762–769.
176.
HawtonK, HallS, SimkinS, . Deliberate self-harm in adolescents: a study of characteristics and trends in Oxford, 1990-2000. J Child Psychol. 2003;44:1191–1198.
177.
HallforsD, ChoH, BrodishPH, . Identifying high school students “at risk” for substance use and other behavioral problems: implications for prevention. Subst Use Misuse. 2006;41:1–15.
178.
GillmanJL, KimHS, AlderSC, . Assessing the risk factors for suicidal thoughts at a nontraditional commuter school. J Am Coll Health. 2006;55:17–26.
179.
Kaltiala-HeinoR, RimpelaM, MarttunenM, . Bullying, depression, and suicidal ideation in Finnish adolescents: school survey. BMJ. 1999;319:348–351.
180.
ForeroR. McLellanl, RisselC, . Bullying behaviour and psychosocial health among school students in New South Wales, Australia: cross-sectional survey. BMJ. 1999;319:344–348.
181.
Kaltiala-HeinoR, RimpelaM, MaritrunenM, . Bullying, depression, and suicidal ideation in Finnish adolescents: school survey. BMJ. 1999;319:348–351.
182.
ConradN.Stress and knowledge of suicidal others as factors in suicidal behavior of high school adolescents. Issues Ment Health Nurs. 1992;13:95–104.
183.
HarkavyFJ, AsnisG, BoeckM, Di FioreJ.Prevalence of specific suicidal behaviours in a high school sample. Am J Psychiatry. 1987;144:1203–1206.
184.
OrbachI, KedemP, GorchoverO, . Fears of death in suicidal and nonsuicidal adolescents. J Abnorm Psychol. 1993;102:553–558.
185.
De WildeE, KienhorstI, DiekstraRFW, . The specificity of psychological characteristics of adolescent suicide attempters. J Am Acad Child Adolesc Psychiatry. 1993;32:51–59.
186.
SteinD, WitzumE, BromD, . The association between adolescents’ attitudes toward suicide and their psychosocial background and suicidal tendencies. Adolescence. 1992;27:949–959.
187.
BrentDA, PerperJA, MoritzG, . Psychiatric sequelae to the loss of an adolescent peer to suicide. J Am Acad Child Adolesc Psychiatry. 1993;32:509–517.
188.
BrentDA, MoritzC.BridgeJ, . CanobbioR.Long-term impact of exposure to suicide: a three-year controlled follow-up. J Am Acad Child Adolesc Psychiatry. 1996;35:646–653.
189.
PfefferCR, MartinsP, MannJ, . Child survivors of suicide: psychosocial characteristics. J Am Acad Child Adolesc Psychiatry. 1997;36:65–74.
190.
HazellP, LewinT.Friends of adolescent suicide attempters and completers. J Am Acad Child Adolesc Psychiatry. 1993;32:76–81.
191.
BollenKA, PhilipsDP.Imitative suicides: a national study of the effects of television news stories. Am Sociol Rev. 1982;47:802–809.
192.
GouldMS.ShafferD.The impact of television movies: evidence of imitation. N Engl J Med. 1986;315:690–694.
193.
HafnerH, SchmidtkeA.Do televised fictional suicide models produce suicides? In: Pfeffer CR. Suicide among youth: perspectives on risk and prevention. Washington (DC): American Psychiatric Press;1989.
194.
GouldMS.Suicide and the media. AnnNAcadY Sci. 2001;932:200–221.; discussion 221-224. In: HendinH, MannJJ, editors. The clinical science of suicide prevention New York (NY): Ann N Acad Y Sci; 2001.
195.
VeltingDM, GouldMS.Suicide contagion. In: MarisRW, SilvermanMM.Review of suicidology. New York (NY): Guilford;1997. p 96–137.
196.
GouldMS, WallensteinS, KleinmanM.Time-space clustering of teenage suicide. Am J Epidemiol. 1990;131:71–78.
197.
GouldMS.WallensteinS, KleinmanM, . Suicide clusters: an examination of age specific effects. Am J Public Health. 1990;80:211–212.
198.
FaulknerAH, CranstonK.Correlates of same-sex sexual behaviour in a random sample of Massachusetts high school students. Am J Public Health. 1998;88:262–266.
199.
FergussonDM, HorwoodLJ, BeautraisAL.Is sexual orientation related to mental health problems and suicidality in young people? Arch Gen Psychiatry. 1999;56:876–880.
200.
GarofaloR, WolfRC, KesselS, . The association between health risk behaviours and sexual orientation among a school-based sample of adolescents. Pediatrics. 1998;101:895–902.
201.
LockJ, Steiner Gay H., lesbian, and bisexual youth risks for emotional, physical, and social problems: results from a community-based survey. J Am Acad Child Adolesc Psychiatry. 1999;38:297–304.
202.
RemafediG, FrenchS, StoryM, . The relationship between suicide risk and sexual orientation: results of a population-based study. Am J Public Health. 1998;88:57–60.
203.
BlakeSM, LedskyR, LehmanT, . Preventing sexual risk behaviours among gay, lesbian, and bisexual adolescents: the benefits of gay-sensitive HIV instruction in schools. Am J Public Health. 2001;91:940–946.
204.
RussellST, JoynerK.Adolescent sexual orientation and suicide risk: evidence from a national study. Am J Public Health. 2001;91:1276–1281.
205.
McDanielJS, PurcellD, D'AugelliAR.The relationship between sexual orientation and risk for suicide: research findings and future directions for research and prevention. Suicide Life Threat Behav. 2001;31:(Suppl)84–105.
206.
BrentDA, BaugherM, BirmaherB, . Compliance with recommendations to remove firearms in families participating in a clinical trial for adolescent depression. J Am Acad Child Adolesc Psychiatry. 2000;39:1220–1226.
207.
ShahS, HoffmanRE, WakeL, . Adolescent suicide and household access to firearms in Colorado: results of a case-control study. J Adolesc Health. 2000;26:157–63.
208.
KellermannAL, RivaraFP, SomesG, . Suicide in the home in relation to gun ownership. N Engl J Med. 1992;327:467–472.
209.
GrossmanDC, MuellerBA, RiedyC, . Gun storage practices and risk of youth suicide and unintentional firearm injuries. JAMA. 2005;293:707–714.
210.
CummingsP, GrossmanDC, RivaraFP, . State gun safe storage laws and child mortality due to firearms. JAMA. 1997;278:1084–1086.
211.
LoftinC, McDowallD, WiersemaB, . Effects of restrictive licensing of handguns on homicide and suicide in the District of Columbia. N Engl J Med. 1991;325:1615–1620.
212.
BoydJH, MoscickiEK.Firearms and youth suicide. Am J Public Health. 1986;76:1240–1242.
213.
BrentDA, PerperJA, Al ImanCJ.Alcohol, firearms, and suicide among youth: temporal trends in Allegheny County, Pennsylvania, 1960 to 1983. JAMA.1987;257:3369–3372.
214.
LesterD.Preventive effect of strict handgun control laws on suicide rates. Am J Psychiatry. 1983;140:1259.
215.
SloanJH, RivaraFP, ReayDT, . Firearm regulations and rates of suicide: a comparison of two metropolitan areas. N Engl J Med. 1990;322:369–373.
216.
CarringtonPJ, MoyerS.Gun control and suicide in Ontario. Am J Psychiatry. 1994;151:606–608.
MannJJ, StoffDM.A synthesis of current findings regarding neurobiological correlates and treatment of suicidal behavior. Ann N Acad Y Sci.1997;836:352–363.
219.
NielsenDA, GoldmanD.VirkkunenM, . Suicidality and 5-hydroxyindoleacetic acid concentration associated with a tryptophan hydroxylase polymorphism. Arch Gen Psychiatry. 1994:51:34–38.
220.
NielsenDA, VirkkunenM, LappalainenJ, . A tryptophan hydroxylase gene marker for suicidality and alcoholism. Arch Gen Psychiatry. 1998;55:593–602.
221.
ArangoV, UnderwoodMD, BoldriniM, . Serotonin 1A receptors, serotonin transporter binding and serotonin transporter mRNA expression in the brainstem of depressed suicide victims. Neuropsychopharmacology. 2001;25:892–903.
222.
KruesiMJ, SwedoSE, HamburgerSD, . Concentration gradient of CSF monoamine metabolites in children and adolescents. Biol Psychiatry. 1988;24:507–514.
223.
RubensteinJL, HeerenT, HousmanD, . Suicidal behavior in “normal” adolescents: risk and protective factors. Am J Orthopsychiatry. 1989;59:59–71.
224.
RubensteinJL, HaltonA, KastenL, . Suicidal behavior in adolescents: stress and protection in different family contexts. Am J Orthopsychiatry. 1998;68:274–284.
225.
ZhangJ, JinS.Determinants of suicide ideation: a comparison of Chinese and American college students. Adolescence. 1996;31:451–467.
226.
PfefferCR, KlermanGL, HurtSW, . Suicidal children grow up: demographic and clinical risk factors for adolescent suicide attempts. J Am Acad Child Adolesc Psychiatry. 1991;30:609–616.
227.
KovacsM, GoldstonD, GatsonisC.Suicidal behaviors and childhood-onset depressive disorders: a longitudinal investigation. J Am Acad Child Adolesc Psychiatry. 1993;32:8–20.
228.
GoldstonDB, DanielS, ReboussinDM, . First-time suicide attempters, repeat attempters, and previous attempters on an adolescent inpatient psychiatry unit. J Am Acad Child Adolesc Psychiatry. 1996;35:631–639.
229.
SteinD, ApterA, RatzoniG, . Association between multiple suicide attempts and negative affects in adolescents. J Am Acad Child Adolesc Psychiatry. 1998;37:488–494.
