In the Journals

Most adolescent suicidal behavior preceded by mental health treatment

A little more than half of adolescents who planned or attempted suicide received some form of mental health treatment, according to new data published in JAMA Psychiatry.

"It is not just depression that is predictive of suicidal behavior, but also disorders characterized by aggressive and impulsive behaviors such as conduct disorder, ADHD and intermittent explosive disorder that are associated with suicide attempts," study researcher Matthew K. Nock, PhD, told Psychiatric Annals. "We need to do much better at identifying those at risk for suicidal behavior and preventing the occurrence of self-harm."

Matthew K. Nock 

Matthew K. Nock

The study included 6,483 adolescents aged 13 to 18 years and their parents. Suicidal behavior, diagnoses of mental disorders and history of treatment were determined through face-to-face household interviews, while parents completed questionnaires about their children’s mental health.

Results indicated that the lifetime prevalence of suicide ideation among adolescents was 12.1%, suicide plans 4%, and suicide attempts 4.1%. One-third of adolescents with suicidal ideation went on to develop a suicide plan and 33.9% made an attempt. Most adolescents (88.4%) who transitioned from planning suicide to attempting suicide did so within a year.

The researchers also found that 15.3% of female adolescents vs. 9.1% of males had suicidal ideation. Among female adolescents, 5.1% made plans and 6.2% attempted suicide vs. 3% of males who planned and 2.1% who attempted.

More than 80% of suicidal adolescents received some form of mental health treatment, whereas more than 55% received treatment before onset of suicidal behaviors. The study did not examine the type or adequacy of treatment the adolescents received.

Most adolescents who had suicidal ideation (89.3%) and attempted suicide (96.1%) met lifetime criteria for at least one DSM-IV mental disorder, which included major depressive disorder, specific phobia, oppositional defiant disorder, substance abuse, intermittent explosive disorder and conduct disorder. Most disorders significantly predicted suicidal behaviors, and the prevalence of mental disorders generally increased with the increasing severity of suicidal behaviors.

“The results point to the need for future work to increase our understanding of the dramatic increase in suicidal behaviors during adolescence, of the causal pathways linking child-adolescent mental disorders to adolescent suicidal behaviors, and of actionable strategies for clinical prediction and prevention of these behaviors,” the researchers wrote.

Disclosure: See the study for a full list of financial disclosures.