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Lethality of first suicide attempt in youth higher than previously thought

An analysis of data from a study published in 2016 demonstrated that 71.4% of completed youth suicides occurred at the index attempt. Findings were published in the Journal of the American Academy of Child & Adolescent Psychiatry.

In addition, firearms were implicated in 85% of lethal first suicide attempts among youth, according to the results.

“To date, most studies examining suicide risk after suicide attempt have relied on convenience samples limited to a particular attempt method, a specific treatment setting, or a specific type of care received after an attempt,” Alastair J.S. McKean, MD, from Mayo Clinic, and colleagues wrote. “As a result, these approaches have systematically overlooked those dying at the index attempt.”

To address these limitations, McKean and colleagues conducted a retrospective-prospective all-age cohort study (n = 1,490) of first suicide attempts coming to medical attention that was published in American Journal of Psychiatry in 2016. Those who died at their index attempt were included in the findings.

The current study focused on the subsample of 813 youth aged 10 to 24 years, of whom 555 were female, with index attempts from January 1, 1986, through December 31, 2007, and followed until December 31, 2010.

Of 813 youth, 29 (3.6%) completed suicide during the study period — 28 died before their 25th birthday and 20 of these 28 died (71.4%) at first attempt, according to the data.

Although only 31.7% of the cohort were men, males accounted for 23 of the 29 completed suicides (79.3% of suicides; 8.9% of males). The investigators also found that 85% of all youth first-attempt suicide deaths involved firearms and that 41.2% of youth had no reported psychiatric history before their index attempt.

Most youth index attempts occurred among those aged 15 to 19 years (53.1%), while those aged 10 to 14 years accounted for 20.2%. Although participants aged 20 to 24 years completed suicide at the highest rate, the researchers found that the largest number of completed suicides by raw number occurred in adolescents aged 15 to 19 years.

"Suicide is a major public health problem affecting American youth and is the second most common cause of death for those between the ages of 10 and 24 years old," McKean said in a press release. “Our findings show the high lethality of index attempt suicides in youth and their close relationship to firearms. This combined with the fact that index suicide attempts are often the first intersection with mental health care is very concerning. Future prevention efforts need to focus on youth before they make their first attempt.” – by Savannah Demko

Disclosure: McKean reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.