Conditions That Predispose to Suicide

Robert L. Findling, MD, MBA


March 25, 2013

This feature requires the newest version of Flash. You can download it here.

Hello. My name is Dr. Robert Findling. This is my first posting since I assumed a new position. I am now the Director of the Division of Child and Adolescent Psychiatry at Johns Hopkins Medicine and of the Kennedy Krieger Institute, both of which are in Baltimore, Maryland.

Today I want to talk about a paper that was published not too long ago in JAMA Psychiatry. That paper, by Nock and colleagues,[1] focuses on lifetime prevalence of suicidal behavior in teenagers.

The tragedy of teen suicide is an all-too-common cause of death in adolescents, and therefore it is important to understand suicidal behavior in this population. Unfortunately, before this analysis, comprehensive studies that use nationally representative cohorts were not really available. The data reported in this paper come from the National Comorbidity Survey Replication, Adolescent Supplement. That work is important because it does include a national survey and it assessed for many psychiatric conditions.

All told, more than 6400 teenagers between the ages of 13 and 18 years received face-to-face interviews. In addition, these youngsters' parents received questionnaires. I should also point out that the data about suicidal behavior were ascertained using a modified version of the suicidal behavior module of the [World Health Organization's] Composite International Diagnostic Interview. In addition, the survey collected information about age at onset, lifetime prevalence regarding suicidal ideation, suicidal plans, and attempts.

What were the key findings? First, overall lifetime prevalence of suicidal ideation was found to be about 12% -- about 15% for girls and 9% for boys. In addition, the prevalence of plans and attempts was around 4%; these are clearly not insignificant numbers. Similar to the findings pertaining to suicidal ideation, girls had higher rates of plans and attempts than boys.

Looking at this longitudinally, about one third of youngsters who have suicidal ideation subsequently develop a plan, and about 60% of those with a plan will eventually attempt suicide. This evolution seems to occur within a 1-year-long timeframe. Of the first attempts made, 60% are unplanned, but conversely and perhaps even more worrisome, 40% of first attempts are indeed planned.

When do these concerning behaviors start? It appears that the onset of suicidal ideation before 10 years of age is not common, occurring in less than 1% of children, but a substantive increase in the rate of suicidal ideation begins at age 12. Suicide plans and attempts also seem to be uncommon in children younger than 12 years of age.

As might be expected, most youths with suicidal ideations indeed suffer from a psychiatric condition. Not surprisingly, depressive disorders were the most prevalent in teenagers who are suicidal. But a key -- and I think very concerning -- finding is that 80% of youths with suicidal ideation, 87.5% with a plan, and more than 90% with an attempt have received treatment. Perhaps more concerning is that most of these youngsters receive treatment before the onset of their suicidal behavior.

Time does not permit me to go into several of the other key findings of this very informative paper, but I think what I presented today at least highlights some of the important findings that the authors described. In short, this work provides key data about the prevalence and severity of suicidal behavior and ideations in teenagers, with an understanding about how big a challenge we face. We can hopefully now move forward and try to make things better for these very vulnerable adolescents.

I'm Dr. Robert Findling. Thank you for watching.