Suicidal Attacks in Children and Adolescents

Suicide is a major public health problem that affects people of all ages, including children and adolescents. A child's decision to commit suicide is influenced by many social and psychological factors, as well as mental illness and addiction. Suicide is defined as death caused by self-directed injurious behavior with an intent to die as a result of the behavior; suicide attempt is defined as a nonfatal, self-directed, potentially injurious behavior with an intent to die as a result of the behavior even if the behavior does not result in injury; and suicidal ideation is defined as thinking about, considering, or planning suicide.

Suicide is the fourth leading cause of death worldwide among 15-29 year-olds (WHO, 2021). Globally, lifetime prevalence rates are approximately 9.2% for suicidal ideation and 2.7% for suicide attempt.

The leading methods of suicide for the 15- to 19-year age group in 2013 were suffocation (43%), discharge of firearms (42%), poisoning (6%), and falling (3%). It is estimated that around 20% of global suicides are due to pesticide self-poisoning, most of which occur in rural agricultural areas in low- and middle-income countries. The availability of potentially lethal drugs may also increase the risk of suicide or at least increase the medical lethality of an attempt.

Although no specific tests are capable of identifying a suicidal person, specific risk factors exist. Some risk factors for suicide can be classified as being modifiable or non-modifiable. Modifiable risk factors are dynamic and may be influenced by treatment (eg. suicidal ideation, current stressors and poor physical health). Non-modifiable risk factors are static and do not change over time (eg. family history of suicide or suicide attempts, history of adoption, male gender, parental mental health problems, history of physical or sexual abuse, and a previous suicide attempt). Personal mental health problems that predispose to suicide include sleep disturbances, depression, substance use disorders, and pathologic Internet use. Social and environmental risk factors include bullying, impaired parent-child relationship, living outside of the home (homeless or in a corrections facility or group home), difficulties in school, social isolation, and presence of stressful life events. Youth seem to be at much greater risk from media exposure than adults and may imitate suicidal behavior seen on television. Media coverage of an adolescent's suicide may lead to cluster suicides, with the magnitude of additional deaths proportional to the amount, duration, and prominence of the media coverage.

The first step in treating a child after a suicide attempt is a control of the vital signs of the patient. The priority is to reverse the life-threatening condition, and then to treat the disease . Options for immediate evaluation include hospitalization, transfer to an emergency department, or a same-day appointment with a mental health professional. Adolescents with a responsive and supportive family, little likelihood of acting on suicidal impulses (e.g., thought of dying with no intent or plan for suicide), and someone who can take action if there is mood or behavior deterioration may require only outpatient treatment.