2017 Children’s Mental Health Report

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Suicide and Self Injury

A threat of suicide should never be dismissed, even from a kid who cries “Wolf!” so many times it’s tempting to stop taking her seriously. It’s important to respond to threats and other warning signs in a serious and thoughtful manner. They don’t automatically mean that a child is going to attempt suicide. But it’s a chance you can’t take.– Nadine Kaslow

Suicide among adolescents is a serious public health issue that takes more lives worldwide each year.

5,000 adolescents

in the United States die by suicide every year.

600,000 United States youth

require medical attention for self-injury each year.

Suicide is now the leading cause of death for girls 15-19 worldwide¹

Suicide is often preceded by a mental health disorder. Although depression is commonly linked to suicide, in teens different disorders like ADHD and anxiety are also a risk.

  • Aggression and impulsivity are traits highly related to suicidal behavior in adolescents.² The younger a person is, the more impulsive aggressiveness contributes to suicide attempts. ³
  • The most prevalent lifetime disorders among suicidal adolescents are depression, followed by impulse control disorders, substance abuse, psychosis and anxiety.
  • 73.2% of suicidal adolescents have been engaged with the mental health system and received treatment.
  • The first year of suicidal thinking presents the highest risk and the most important target for intervention. 63.1% of adolescents who plan suicide transition from ideation to plan within the first year of onset of ideation; 86.1% of those who attempt suicide transition from ideation to attempt within a year.


Reducing the incidence of teen suicide requires understanding the progression of adolescent mental health disorders, and identifying young people at risk of suicidal thoughts and actions who are already engaged with the mental health system.

Non-suicidal self injury (NSSI) is a separate phenomenon from suicidal ideation and attempts, but research shows that they are related.

  • People who engage in self injury say it helps them feel better, that it reduces unwanted feelings and increases wanted feelings. Studies demonstrate that physical pain may interfere with or obscure the physiological signs of emotional pain, a phenomenon known as “pain offset relief.”
  • In a large study of adolescents, 46.5% reported hurting themselves within past year, most frequently: biting self, cutting, hitting self, burning skin
    • 60% of these (28% overall) reported moderate to severe NSSI
    • Self-injurers hurt themselves on average once a month
  • NSSI behaviors still may increase risk of suicide by reducing the individual’s fear of pain and injury over time, removing a barrier to completing suicide.

[1] World Health Organization. (2014). Preventing suicide: A global imperative. Geneva, Switzerland: Author.

[2] Apter, A., Gothelf, D., Orbach, I., Weizman, R., Ratzoni, G., Har-Even, D., & Tyano, S. (1995). Correlation of Suicidal and Violent Behavior in Hospitalized Adolescent Patients. Journal of the American Academy of Child & Adolescent Psychiatry, 34(7), 912-918. doi:10.1097/00004583-199507000-00015

[3] Brent, D. A., Kolko, D. J., Wartella, M. E., Boylan, M. B., Moritz, G., Baugher, M., & Zelenak, J. P. (1993). Adolescent Psychiatric Inpatients’ Risk of Suicide Attempt at 6-Month Follow-up. Journal of the American Academy of Child & Adolescent Psychiatry, 32(1), 95-105. doi:10.1097/00004583-199301000-00015

[4] Nock, M. K., Green, J. G., Hwang, I., McLaughlin, K. A., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2013). Prevalence, correlates and treatment of lifetime suicidal behavior among adolescents: Results from the NCS-A. JAMA Psychiatry70(3), doi:10.1001/2013.jamapsychiatry.55.

[5] Nock (2013).

[6] Nock (2013).

[7] Nock, M. K., Heilbron, N., Franklin, J. C., Guerry, J. D., & Prinstein, M. J. (2014). Social and Ecological Approaches to Understanding Suicidal Behaviors and Nonsuicidal Self-Injury. The Oxford Handbook of Suicide and Self-Injury. doi:10.1093/oxfordhb/9780195388565.013.0012

[8] Lloyd-Richardson, E. E., Perrine, N., Dierker, L., & Kelley, M. L. (2007). Characteristics and functions of non-suicidal self-injury in a community sample of adolescents. Psychological Medicine, 37(8), 1183–1192. doi:10.1017/S003329170700027X

[9] Joiner, T. E., Ribeiro, J. D., & Silva, C. (2012). Nonsuicidal Self-Injury, Suicidal Behavior, and Their Co-occurrence as Viewed Through the Lens of the Interpersonal Theory of Suicide. Current Directions in Psychological Science, 21(5), 342-347. doi:10.1177/0963721412454873