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With Suicide Now Teens’ Second-Leading Cause of Death, Pediatricians Urged to Ask About Its Risks

6/27/2016

In updated clinical report, American Academy of Pediatrics highlights the role bullying, internet use and other factors play in adolescent suicide.

Elk Grove Village, IL - With suicide rising to the second-leading cause of death among adolescents, the American Academy of Pediatrics (AAP) is publishing updated guidelines advising pediatricians how to identify and help teens at risk.  

In a clinical report, “Suicide and Suicide Attempts in Adolescents” in the July 2016 Pediatrics (published online June 27), the AAP urges pediatricians to screen patients for suicidal thoughts and identifies risk factors linked to teen suicide attempts, such as bullying and pathological internet use. 

The report replaces a previous version that was published in 2007. At that time, suicide was the third-leading cause of death for adolescents 15 to 19 years old; now it is second, having passed up homicide. Only unintentional injuries, such as motor vehicle crashes and inadvertent poisonings, claim the lives of more teens. 

According to the AAP, risk factors for suicide attempts include a family history of suicide, a history of physical or sexual abuse, mood disorders, drug and alcohol use, and lesbian, gay, bisexual or questioning sexual orientation or transgender identification. An important additional risk factor for suicide is bullying. 

“Bullying has always been a major issue for adolescents, but there is now greater recognition of the connection between bullying and suicide,” said the AAP report’s lead author, Benjamin Shain, MD, PhD.

“The Internet is a key influence, as well. Cyberbullying, for example, is as serious a problem as face-to-face bullying,” said Dr. Shain, a child psychiatrist with NorthShore University HealthSystem.

Internet use that exceeds 5 hours a day is linked to higher levels of depression and suicidal thoughts among adolescents, although the Internet may also be an important source of support for them. Adolescents are also at higher risk of suicide attempts if they have a strained parent-child relationship, live outside the home, have difficulties in school or are not attending school. Protective factors cited include religious involvement and connection between the youth and parents, school, and peers.

Suicide rates vary based on race and gender, according to the clinical report. Girls make more suicide attempts, but boys die from suicide at a rate three times higher than girls because they tend to choose more lethal methods, such as firearms. Firearms in the home are a particular danger, according to the AAP, with studies showing the risk of suicide is 4 to 10 times higher in homes with guns than in those without. The AAP recommends any firearm be kept locked up, with the ammunition stored separately.

But however they are stored, firearms in the home are associated with a high risk of adolescent suicide. The AAP recommends that parents of adolescents at risk for suicide remove guns and ammunition from the house.

The AAP recommends pediatricians routinely ask adolescent patients if they have thoughts of harming themselves, and screen for other factors associated with increased suicide risk. Pediatricians should refer patients for appropriate mental health evaluation and treatment when needed. Antidepressants medications are a valuable treatment option, according to the AAP. Since “black box” warning labels were added to antidepressants in 2004, new research has indicated that the benefits of these medications outweigh the risks for many patients.

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The American Academy of Pediatrics is an organization of 64,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org.