Risk Factors for Suicidal Behavior in Children and Adolescents

Type

Examples

Psychiatric disorders and physical disorders that affect the brain

Mood disorders* (eg, schizophrenia, depressive disorders)

Schizophrenia

Substance use, particularly alcohol and THC† and/or substance use in adolescents

Aggressive, impulsive tendencies (conduct disorder)

Previous suicide attempts

Traumatic head injury (TBI)

Posttraumatic stress disorder (PTSD)

Anxiety disorders

Family history

Family history of suicidal behavior

Increased rates of suicide in adults

Parental opioid use‡

Mother with a mood disorder

Father with a history of trouble with the police

Poor communication with parents

Psychosocial factors

Recent disciplinary action§ (most commonly, school suspension)

Interpersonal loss (loss of a girlfriend or boyfriend, especially in boys; separation from parents)

Difficulties in school

Social isolation (particularly not working or going to college)

Minority in upwardly mobile home

Victim of bullying

Media reports of suicide (copycat suicide)

Sexual/gender minority status

Environmental factors

Easy access to lethal methods (eg, guns)

Barriers to and/or stigma associated with accessing mental health services

Medications

a

b

Selective serotonin reuptake inhibitorsc, d

d

Benzodiazepinesd

* Mood disorders are present in more than one half of suicidal adolescents.

Gobbi G, Atkin T, Zytynski, et al: Association of cannabis use in adolescence and risk of depression, anxiety, and suicidality in young adulthood: A systematic review and meta-analysis. JAMA Psychiatry 76(4):426-434, 2019. doi: 10.1001/jamapsychiatry.2018.4500.

Turecki G, Brent DA, Gunnell D, et al: Suicide and suicide risk. Nat Rev Dis Primers 5(1):74, 2019. doi: 10.1038/s41572-019-0121-0.

§ Almost half of completed suicides occur after recent disciplinary action.

Bremner JD, Shearer K, McCaffery: Retinoic acid and affective disorders: The evidence for an association. J Clin Psychiatry 73(1):37-50, 2012.

aBenard B, Bastein V, Vinet B, et alEur Respir J 50(2):1700148. doi: 10.1183/13993003.00148-2017.

bMolero Y, Larsson H, D'Onofrio B, et al: Associations between gabapentinoids and suicidal behaviour, unintentional overdoses, injuries, road traffic incidents, and violent crime: Population based cohort study in Sweden. BMJ Clin Res 365:12147, 2019. doi: 10.1136/bmj.l2147.

cGibbons RD, Brown CH, Hur K, et al: Early evidence on the effects of regulators' suicidality warnings on SSRI prescriptions and suicide in children and adolescents. Am J Psychiatry 164(9);1356-1363, 2007. doi: 10.1176/appi.ajp.2007.07030454.

dGibbons R, Hur K, Lavigne J, et al: Medications and suicide: High dimensional empirical Bayes screening (iDeas). Harvard Data Sci Rev 1.2 2019 (revised 2020). doi: 10.1162/99608f92.6fdaa9d