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Prevalence, Correlates, and Treatment of Lifetime Suicidal Behavior Among Adolescents: Results From the National Comorbidity Survey Replication Adolescent Supplement
Open accessAbstract
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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“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
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“In the National Comorbidity Replication Sample Adolescents study (n=6483), of the 4% of adolescents who reported suicide attempts, 80% reported receiving some kind of mental health treatment in their lifetime, with 55% having begun treatment before the suicidal behavior.”
From Suicide in young people: screening, risk assessment, and intervention (2023) · cites this paper as [101]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“Interestingly, epidemiological data suggest that the most dramatic increase in the incidence of suicidal ideation and behavior occurs between 12 and 17 years of age. (Nock et al. 2013).”
From Adolescent Suicide as a Failure of Acute Stress-Response Systems. (2019) · cites this paper as Nock et al. 2013
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“Only a third of adolescents who have suicidal thoughts are estimated to go on to make a suicide attempt.1”
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]
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“Although this report included data from a national sample that is similar to the population of US adolescents on a wide range of sociodemographic/geographic variables, treatment was self-reported and no data were collected on the adequacy of treatment.”
From Suicide in young people: screening, risk assessment, and intervention (2023) · cites this paper as [101]
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In the citing paper
“prior evidence shows one-third of youth with suicidal ideation will develop a suicide plan, and 60% with a plan will make a suicide attempt [7].”
From The effect of a therapeutic smartphone application on suicidal ideation in young adults: Findings from a randomized controlled trial in Australia. (2022) · cites this paper as [7]
The cited source says what the claim attributes to it.
In the citing paper
“prior evidence shows one-third of youth with suicidal ideation will develop a suicide plan, and 60% with a plan will make a suicide attempt [7].”
From The effect of a therapeutic smartphone application on suicidal ideation in young adults: Findings from a randomized controlled trial in Australia. (2022) · cites this paper as [7]
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In the citing paper
“~40% of people dying by suicide have previously attempted suicide, and long-term follow-up studies have indicated that the risk of suicide amongst people who survived a suicide attempt is 1.6% within 12 months 86 and ~4% at 5 years 87 .”
From Suicide and suicide risk (2019) · cites this paper as [86]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“~40% of people dying by suicide have previously attempted suicide, and long-term follow-up studies have indicated that the risk of suicide amongst people who survived a suicide attempt is 1.6% within 12 months 86 and ~4% at 5 years 87 .”
From Suicide and suicide risk (2019) · cites this paper as [86]
Experimental — accuracy not yet measuredIn the citing paper
“A history of suicidal behavior is a leading predictor of future suicide in youth,16,17”
From Trends in Suicide Among Youth Aged 10 to 19 Years in the United States, 1975 to 2016 (2019) · cites this paper as [17]
In the citing paper
“Although sex differences in STB and NSSI are well documented (4, 5, 7), there is insufficient evidence showing discrete neural circuitry underlying these effects.”
From Neural correlates associated with suicide and nonsuicidal self-injury in youth (2021) · cites this paper as [4]
In the citing paper
“Several correlates and predictors of STBs have been identified, but most are strongly associated with suicide ideation and only weakly related to attempts (Nock et al. 2013; Stewart et al. 2017a; Mortier et al. 2018).”
From Life stress and suicide in adolescents (2019) · cites this paper as Nock et al. 2013
In the citing paper
“As rates of STBs surge in adolescence (Nock et al. 2013)”
From Life stress and suicide in adolescents (2019) · cites this paper as Nock et al. 2013
In the citing paper
“Depression is among the strongest correlates of suicide ideation, and in adolescents, the presence of a unipolar mood disorder increases odds of subsequent suicide ideation by more than 4-fold (Nock et al. 2013).”
From Life stress and suicide in adolescents (2019) · cites this paper as Nock et al. 2013
In the citing paper
“Although depression is generally more strongly associated with suicide ideation than attempts (Nock et al. 2013)”
From Life stress and suicide in adolescents (2019) · cites this paper as Nock et al. 2013
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Metadata
- 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)
- ORCID
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2013-03-01
- Volume
- 70
- Issue
- 3
- Pages
- 300
- ISSN
- 2168-622X (ISSN-L)
- PMC
- PMC3886236
- 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
- green
- europepmc.org
- 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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