Rethinking Lethality in Youth Suicide Attempts: First Suicide Attempt Outcomes in Youth Ages 10 to 24
Open accessAbstract
Objective Although suicide is the second most frequent cause of death in American youth, suicide research has heretofore been confined to convenience samples that represent neither psychiatric nor general populations and that fail to include individuals dying at their first attempts. These limitations were addressed by assembling a youth cohort followed from the first medically recorded attempt (index attempt [IA]). It was hypothesized this approach would more accurately represent the prevalence of completed suicide after an attempt and underscore lethality based on method.Method This study draws from a previously reported retrospective-prospective all-age cohort identified through the Rochester Epidemiology Project. The original 1,490-subject sample included 813 Olmsted County youth 10 to 24 years old (n = 258 male, n = 555 female; 54.6% of total cohort) with IAs from January 1, 1986 through December 31, 2007 and followed until December 31, 2010.Results Twenty-nine of 813 subjects (3.6%) killed themselves during the study period, with 28 of 29 dying before their 25th birthday and 20 of 28 (71.4%) dying at their first attempt. Despite composing only 31.7% of the cohort (258 of 813), male subjects composed most suicides: 23 of 29 (79.3% of suicides; 8.9% of male subjects) versus 6 of 29 female subjects (20.7% of suicides; 1.1% of female subjects). Eighty-five percent of all IA deaths involved firearms. More than a third of youth-41.2%-lacked a psychiatric history prior to IA.Conclusion These data show that more than half the IAs occurred in youth, with approximately three-fourths of completed youth suicides occurring at the IAs. In parsing cause of IA death in the all-age cohort, the contribution of firearms figured even more prominently in the subsample of youth (85.0%) than in those at least 25 years old (64.3%). The high IA lethality suggests that prevention efforts commencing after the IA are too late for most victims.
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The majority of youth suicides occur in an initial attempt.
“Considering that the majority of youth suicides occur in an initial attempt (21)”
From Structural Racism and Suicide Prevention for Ethnoracially Minoritized Youth: A Conceptual Framework and Illustration Across Systems (2022) · cites this paper as [21]
Sex differences in STB and NSSI are well documented, but there is insufficient evidence showing discrete neural circuitry underlying these effects.
“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 [5]
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Stone, C. B. (2022) · Teaching and Supervision in Counseling · doi:10.7290/tsc04n2mz · Cited by 2 · see citing works
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Handgun carrying and suicidality: An analysis of Florida adolescents
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Interacting immediate and long-term action regulation in suicidal behavior
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Psychiatric Prognosis Following Index Suicide Attempts in Early Adolescents
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Self-citationRisk and protective factors of near-lethal suicide attempts in adolescents
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- Authors
- McKean, A. J. S., Pabbati, C. P., Geske, J. R., & Bostwick, J. M.
- Affiliations
- Mayo Clinic (US)
- University of California San Diego (US)
- Corresponding author
- McKean, Alastair J.S.
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2018-10
- Volume
- 57
- Issue
- 10
- Pages
- 786-791
- ISSN
- 0890-8567 (ISSN-L)
- PMC
- PMC6375682
- OpenAlex
- W2888736473
- Cited by
- 83
- References
- 25
- Citations by year
- 2026: 3 · 2025: 12 · 2024: 13 · 2023: 6 · 2022: 12 · 2021: 19 · 2020: 5 · 2019: 11 · 2018: 2
- FWCI
- 10.85
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (U01AG-45390)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Injury Epidemiology and Prevention
- Keywords
- youth suicide, suicide attempts, suicide lethality, suicide mortality, firearm suicide, suicide prevention, sex differences in suicide, psychiatric history, Rochester Epidemiology Project
- MeSH terms
- Adolescent, Adult, Child, Female, Firearms, Humans, Male, Risk Factors, Suicide, Attempted, Prevalence, Young Adult
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