Cited by 1,666Suicide and Self-Harm StudiesHomicide, Infanticide, and Child AbuseGun Ownership and Violence Research

Prevalence, Correlates, and Treatment of Lifetime Suicidal Behavior Among Adolescents: Results From the National Comorbidity Survey Replication Adolescent Supplement

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Nock, Matthew K., Green, Jennifer Greif, Hwang, Irving, McLaughlin, Katie A., Sampson, Nancy A., Zaslavsky, Alan M., Kessler, Ronald C.·2013·JAMA Psychiatry

Abstract

CONTEXT: Although suicide is the third leading cause of death among US adolescents, little is known about the prevalence, correlates, or treatment of its immediate precursors, adolescent suicidal behaviors (ie, suicide ideation, plans, and attempts). OBJECTIVES: To estimate the lifetime prevalence of suicidal behaviors among US adolescents and the associations of retrospectively reported, temporally primary DSM-IV disorders with the subsequent onset of suicidal behaviors. DESIGN: Dual-frame national sample of adolescents from the National Comorbidity Survey Replication Adolescent Supplement. SETTING: Face-to-face household interviews with adolescents and questionnaires for parents. PARTICIPANTS: A total of 6483 adolescents 13 to 18 years of age and their parents. MAIN OUTCOME MEASURES: Lifetime suicide ideation, plans, and attempts. RESULTS: The estimated lifetime prevalences of suicide ideation, plans, and attempts among the respondents are 12.1%, 4.0%, and 4.1%, respectively. The vast majority of adolescents with these behaviors meet lifetime criteria for at least one DSM-IV mental disorder assessed in the survey. Most temporally primary (based on retrospective age-of-onset reports) fear/anger, distress, disruptive behavior, and substance disorders significantly predict elevated odds of subsequent suicidal behaviors in bivariate models. The most consistently significant associations of these disorders are with suicide ideation, although a number of disorders are also predictors of plans and both planned and unplanned attempts among ideators. Most suicidal adolescents (>80%) receive some form of mental health treatment. In most cases (>55%), treatment starts prior to onset of suicidal behaviors but fails to prevent these behaviors from occurring. CONCLUSIONS: Suicidal behaviors are common among US adolescents, with rates that approach those of adults. The vast majority of youth with suicidal behaviors have preexisting mental disorders. The disorders most powerfully predicting ideation, though, are different from those most powerfully predicting conditional transitions from ideation to plans and attempts. These differences suggest that distinct prediction and prevention strategies are needed for ideation, plans among ideators, planned attempts, and unplanned attempts.

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Crossref · 10.1001/2013.jamapsychiatry.55

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  • Few developmentally based theories explain why suicidal ideation and behaviors increase in prevalence at the adolescent transition.

    “As reviewed above, few developmentally based theories have been offered to help explain why suicidal ideation and behaviors increase in prevalence at the adolescent transition (Nock et al. 2013).”

    From Adolescent Suicide as a Failure of Acute Stress-Response Systems. (2019) · cites this paper as Nock et al. 2013

    The Results (Prevalence and age-of-onset; page not supplied) show that suicidal ideation, plans, and attempts increase during adolescence. The Comment calls for further work to understand that increase, but does not say that few developmentally based theories have been offered. (LLM, conf=0.86)

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  • Suicidal ideation and behavior increase dramatically in prevalence at the adolescent transition worldwide.

    “the worldwide trend for suicidal ideation and behavior to increase dramatically in prevalence at the adolescent transition (Nock et al. 2013)”

    From Adolescent Suicide as a Failure of Acute Stress-Response Systems. (2019) · cites this paper as Nock et al. 2013

    The Results section reports that suicidal ideation rises more rapidly between ages 12 and 17, while plans and attempts increase after age 12. The study concerns US adolescents, so it does not establish that this prevalence pattern occurs worldwide. (LLM, conf=0.86)

    Experimental — accuracy not yet measured
  • Many well established risk factors for suicide, such as depression, impulsivity, and hopelessness, do not meaningfully differentiate individuals with suicidal thoughts from those who have made an attempt.

    “Several large epidemiological and meta-analytical studies provide empirical support for this framework and have found that many well established risk factors for suicide (such as depression, impulsivity, and hopelessness) do not meaningfully differentiate individuals with suicidal thoughts from those who have made an attempt.1, 5, 6, 7”

    From Predictors of future suicide attempt among adolescents with suicidal thoughts or non-suicidal self-harm: a population-based birth cohort study (2019) · cites this paper as [1]

    In Results (page unavailable), prior mental disorders are more strongly associated with ideation than with attempts among ideators, supporting the general point. But the Comment (page unavailable) says MDD/dysthymia predicts the transition from ideation to an attempt, and intermittent explosive disorder predicts planned attempts. The paper does not establish the claim about hopelessness, and its findings concern adolescents. (LLM, conf=0.87)

    Experimental — accuracy not yet measured
  • Suicidal thoughts and non-suicidal self-harm are strongly associated with suicide attempts.

    “Suicidal thoughts and non-suicidal self-harm are strongly associated with suicide attempts.”

    From Predictors of future suicide attempt among adolescents with suicidal thoughts or non-suicidal self-harm: a population-based birth cohort study (2019) · cites this paper as [1]

    The Results section (Prevalence and age-of-onset of suicidal behaviors; page unavailable) reports that 33.9% of adolescents with suicidal ideation made an attempt, supporting the link between suicidal thoughts and attempts. The Methods section (Measures; page unavailable) assesses ideation, plans, and attempts, but not non-suicidal self-harm; searches for that term and related terms found no evidence for the self-harm part of the claim. (LLM, conf=0.88)

    Experimental — accuracy not yet measured
  • Nonfatal suicidal behaviour is among the most robust predictors of future suicidal behaviour and suicide death.

    “Nonfatal suicidal behaviour is among the most robust predictors of future suicidal behaviour and suicide death.”

    From Suicide and suicide risk (2019) · cites this paper as [86]

    The Results section reports that, among adolescents with suicidal ideation, having a suicide plan was strongly associated with an attempt (OR=5.3). The Comment section likewise reports that approximately 60% of adolescents with a plan made an attempt. These findings support a narrower link between a nonfatal suicidal behavior and a later attempt, but the paper does not establish that nonfatal suicidal behavior generally is among the most robust predictors, or address prediction of suicide death. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

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Authors
Nock, M. K., Green, J. G., Hwang, I., McLaughlin, K. A., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C.
Affiliations
  • Harvard University (US)
  • Boston University (US)
Venue
JAMA Psychiatry
Published
2013-03-01
Volume
70
Issue
3
Pages
300
ISSN
2168-622X (ISSN-L)
OpenAlex
W1985163828
Cited by
1,666
References
50
Citations by year
2026: 102 · 2025: 143 · 2024: 144 · 2023: 155 · 2022: 168 · 2021: 173 · 2020: 149 · 2019: 127 · 2018: 114 · 2017: 93 · 2016: 92 · 2015: 87 · 2014: 88 · 2013: 30
FWCI
110.02
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion)
Funders
  • John D. and Catherine T. MacArthur Foundation (R13-MH066849)
  • John W. Alden Trust
  • Bristol-Myers Squibb
  • Eli Lilly and Company
  • Pfizer
  • AstraZeneca
  • GlaxoSmithKline
  • Sanofi
  • National Institutes of Health (5r13mh066849-04, 5r01mh069864-04, 5r01mh070884-05)
  • Pfizer Foundation (R01‐MH069864, R01-DA016558, R13-MH066849, R03-TW006481)
  • Pan American Health Organization
  • National Institute of Mental Health (R13-MH-066849, R01-MH66627, R01MH066627, R01‐MH070884, R01-DA016558, MH-092526, R01MH077883, K01MH085710, U01-MH-60220, MH60220, MH070884, K01MH092526, U01MH060220, R01‐MH069864)
  • National Institute on Drug Abuse (K05DA015799, R01DA016558)
  • Fogarty International Center (FIRCA R03TW006481, R03TW006481)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
  • Social Sciences › Health › Gun Ownership and Violence Research
Keywords
adolescent suicide, suicidal ideation, suicide planning, suicide attempts, lifetime prevalence, comorbid mental disorders, substance use disorders, disruptive behavior disorders, psychotherapy, suicide prevention
MeSH terms
Adolescent, Adolescent Behavior, Mental Disorders, Black or African American, Educational Status, Ethnicity, Female, Hispanic or Latino, Humans, Male, Sex Factors, Suicide, Suicide, Attempted, United States, Prevalence, Age of Onset, White People, Suicidal Ideation

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