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Cited by 135Suicide and Self-Harm StudiesHomicide, Infanticide, and Child AbuseInjury Epidemiology and Prevention

Suicide in young people: screening, risk assessment, and intervention

Open access
Hughes, Jennifer L, Horowitz, Lisa M, Ackerman, John P, Adrian, Molly C, Campo, John V, Bridge, Jeffrey A·2023·BMJ
DOI 10.1136/bmj-2022-070630PMC PMC11741005
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Abstract

Suicide is the fourth leading cause of death among young people worldwide and the third leading cause of death among those in the US. This review outlines the epidemiology of suicide and suicidal behavior in young people. It discusses intersectionality as an emerging framework to guide research on prevention of suicide in young people and highlights several clinical and community settings that are prime targets for implementation of effective treatment programs and interventions aimed at rapidly reducing the suicide rate in young people. It provides an overview of current approaches to screening and assessment of suicide risk in young people and the commonly used screening tools and assessment measures. It discusses universal, selective, and indicated evidence based suicide focused interventions and highlights components of psychosocial interventions with the strongest evidence for reducing risk. Finally, the review discusses suicide prevention strategies in community settings and considers future research directions and questions challenging the field.

Verified 2026-10-11 · 1 reference not checked yet

Integrity signals

Registry

Crossref · 10.1136/bmj-2022-070630

Cites

161 of 164 references verified0 citation errors · 2 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

41 of 99 cited sources checked · 17 supported · 1 flagged · accuracy not yet measured

  • Premisecitation

    No evidence showing effectiveness of gatekeeper training, alone without other interventions, in preventing suicidal behaviors is available.

    “No evidence showing effectiveness of gatekeeper training, alone without other interventions, in preventing suicidal behaviors is available.103”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [103] source

      The Results section on educational and workplace settings (page not provided) reports a reduction in suicide attempts associated with a training intervention delivered to U.S. naval instructors. That is contrary to the claim that no evidence of effectiveness for training without other interventions is available, although the passage does not explicitly call the intervention gatekeeper training. (LLM, conf=0.82)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
  • Findingcitation

    Living in a home with firearms is associated with a threefold to fourfold increased risk of suicide among young people.

    “Living in a home with firearms is associated with a threefold to fourfold increased risk of suicide among young people.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
  • Findingcitation

    Although rare, suicidal thoughts and suicide attempts have been reported in children as young as 3-7 years.

    “Although rare, suicidal thoughts and suicide attempts have been reported in children as young as 3-7 years,”
    Quote in the paperNot a substantial claim1 of 1 sources checked
  • Findingcitation

    Several studies have refuted the iatrogenic risk myth, that asking questions about suicide can cause harm.

    “Several studies have refuted this iatrogenic risk myth, that asking questions about suicide can cause harm.”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [92] source

      The Discussion conclusion says that the few studies testing this question suggest asking about suicidal thoughts is not associated with increased suicidal ideation. But the paper does not say they have refuted all possible harm: it describes the evidence as limited and says causal relationships cannot feasibly be tested in at-risk populations. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [93] source
  • Findingcitation

    A more thorough assessment with a clinician can have therapeutic value, particularly in engaging adolescents in treatment.

    “A more thorough assessment with a clinician can have therapeutic value, 96 particularly in engaging adolescents in treatment.”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [96] source

      The ‘Therapeutic risk assessment and formulation’ section says that a thoughtful clinician–patient assessment can build therapeutic rapport and affect patient engagement and recovery. The ‘Patients’ experience of risk assessment’ section also describes therapeutic benefits. The paper does not specifically say that this approach is particularly valuable for engaging adolescents in treatment; its conclusion describes applicability across age groups. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [97] source
  • May combine two claims. 41
  • Classified as probably not a substantial claim. 21
  • The quote only partly states this claim. 1

  • May combine two claims.

    Findingcitation

    A subsequent study found suicide rates in children <13 years to be twice as high for black children as for white children during 2001-15, a finding observed in boys and girls.

    “A subsequent study found suicide rates in children <13 years to be twice as high for black children as for white children during 2001-15, a finding observed in boys and girls”
    Quote in the paperNot a substantial claim1 of 1 sources checked

  • May combine two claims.

    Findingcitation

    An analysis of suicide trends from 1993 to 2012 found that rates remained constant overall in children aged 5-11 years, yet increased significantly in black children, while decreasing in white children; small sample sizes did not allow conclusions for American Indian/Alaska Native and Asian/Pacific Islander children.

    “An analysis of suicide trends from 1993 to 2012 found that rates remained constant overall in children aged 5-11 years, yet increased significantly in black children, while decreasing in white children; small sample sizes did not allow conclusions for American Indian/ Alaska Native and Asian/Pacific Islander children.”
    Quote in the paperNot a substantial claim1 of 1 sources checked

  • May combine two claims.

    Findingcitation

    A gender paradox exists in that suicide rates among young males are roughly three times higher than suicide rates in females, whereas rates of suicidal ideation, suicide plans, and non-fatal suicide attempts are higher in females.

    “A gender paradox exists in that suicide rates among young males are roughly three times higher than suicide rates in females, whereas rates of suicidal ideation, suicide plans, and non-fatal suicide attempts are higher in females.”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites [9] source

      The Gender section (p. 2) describes the gender paradox: completed suicide is generally higher among young males, while suicidal ideation and attempts are higher among females after puberty. The Suicidal ideation section (p. 1) also reports higher rates in girls for ideation with intent or a plan. The copy does not establish a general three-to-one male-to-female suicide-rate ratio, and it identifies China as an exception to the mortality pattern. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [10] source

      The Problem section says youth suicide rates are at least 2–3 times higher in boys than girls in developed countries, and the Suicide attempts section reports higher prevalence of suicidal ideation and attempts in girls aged 12–24. The paper describes this as a gender paradox, but our copy does not establish higher rates of suicide plans in females; the stated rate comparison is also limited to developed countries. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [11] Abraham, 2017, Adolescent suicide as a global public health issue, Int J Adolesc Med Health source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Intersectionality theory posits that social categories such as sex, race/ethnicity, socioeconomic status, gender identity, and sexual orientation intersect to reflect multiple individual attributes and social contexts that influence health and risk behaviors.

    “Intersectionality theory posits that social categories such as sex, race/ethnicity, socioeconomic status, gender identity, and sexual orientation intersect to reflect multiple individual attributes and social contexts that influence health and risk behaviors.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [42] source

      Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Interpretationcitation

    Some of the potential mechanisms underlying risk in sexual minority, transgender, and/or gender diverse youth include victimization/bullying, familial rejection, and internalized stigma, which may be mitigated by affirming school culture, family support, and inclusive and protective health policies.

    “Some of the potential mechanisms underlying risk in sexual minority, transgender, and/or gender diverse youth include victimization/bullying, familial rejection, and internalized stigma, which may be mitigated by affirming school culture, family support, and inclusive and protective health policies .26”
    Quote in the paperSubstantial claim1 of 1 sources checked

  • May combine two claims.

    Findingcitation

    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.

    “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.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [101] source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    BIPOC young people may also be less connected to mental health treatment and be more likely to present in the emergency department with problems other than mental ill health.

    “BIPOC young people may also be less connected to mental health treatment and be more likely to present in the emergency department with problems other than mental ill health.”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [87] source

      The section on risk factors through a JEDI lens reports disparities in Black and Brown youths’ use of behavioral health services, supporting the treatment-connection part of the claim. Neither that section nor the passages on assessment and treatment address whether BIPOC youths are more likely to present to emergency departments with problems other than mental ill health. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
    • cites [88] source

  • May combine two claims.

    Study design and conductcitation

    In that report, treatment was self-reported and no data were collected on the adequacy of treatment.

    “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.”
    Quote in the paperNot a substantial claim1 of 1 sources checked

  • May combine two claims.

    Findingcitation

    Family cohesion, increased access to care, faith/spiritual factors, cognitive flexibility and emotion regulation skills, and strong interpersonal relationships have been identified as conferring protection against suicidal behavior in young people.

    “Family cohesion, increased access to care, faith/spiritual factors, cognitive flexibility and emotion regulation skills, and strong interpersonal relationships have been identified as conferring protection against suicidal behavior in young people.”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites [11] Abraham, 2017, Adolescent suicide as a global public health issue, Int J Adolesc Med Health source
    • cites [36] source

      The Familial Factors and Suicidality Protective Factors sections identify family cohesion, religious ties, and supportive social relationships as protective against suicidality among African American adolescents. The Personal Factors section identifies some protective coping strategies, but does not establish cognitive flexibility or emotion-regulation skills as protective; it reports that emotion-focused coping was not protective. The reviewed passages also do not identify increased access to care as a protective factor, and the review's population is narrower than young people generally. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [37] source

      The “Coping” section reports that support from family and friends is associated with lower levels of depression and suicide among African American youth, but says the direction of effect is unknown. It describes spirituality as a hypothesized protective factor while stating that research has not shown the same protective impact in African American youth. The cited passages do not establish family cohesion, increased access to care, cognitive flexibility, or emotion-regulation skills as protective against suicidal behavior; the claim is also broader than the paper’s focus on African American adolescents. Page numbers were not provided in our copy. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingcitation

    Disposition based on screening alone can fail to respond appropriately to real suicide risk and result in inefficient use of resources.

    “Once a patient screens positive for suicide risk, a follow-up assessment is a critical best practice, as disposition based on screening alone can fail to respond appropriately to real suicide risk and result in inefficient use of resources.”
    Quote in the paperSubstantial claim2 of 2 sources checked
    • Rests on an assumption: Screening for suicide risk can identify young people at high risk.

  • May combine two claims.

    Findingcitation

    Mathias and colleagues found that suicidal ideation declined compared with baseline after repeated assessments using the Suicidal Ideation Questionnaire-Junior in a population at risk; this suggests that screening is safe and may be helpful to teens struggling with suicidal ideation.

    “Mathias and colleagues actually found that suicidal ideation declined compared with baseline after repeated assessments using the Suicidal Ideation Questionnaire-Junior in a population at risk; this suggests that screening is safe and may be helpful to teens struggling with suicidal ideation.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [92] source

      Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    A recent metaanalysis of self-guided mobile technologies indicated promise, but none has shown superiority over a control condition.

    “A recent metaanalysis of self-guided mobile technologies indicated promise, but none has shown superiority over a control condition.165”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [165] source

      The Discussion (Principal Findings) says the interventions show promise, and the Conclusions report no significant reduction in suicidal ideation versus a control condition for iBobbly, Virtual Hope Box, or TEC. But Strengths and Limitations says the authors could not conduct a meta-analysis. Moreover, Results (Study Characteristics) reports that TEC reduced several self-injurious outcomes compared with a control app, so the claim that none showed superiority is too broad. (LLM, conf=0.90)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Gatekeeper training programs for parents and teachers show improvements in knowledge of gatekeepers but may not lead to behavior change that results in identification or referral of suicidal young people to further services.

    “Gatekeeper training programs for parents and teachers show improvements in knowledge of gatekeepers but may not lead to behavior change that results in identification or referral of suicidal young people to further services.158”
    Quote in the paperNot a substantial claim1 of 1 sources checked

  • May combine two claims.

    Premisecitation

    Systematic reviews of school based programs consistently indicate improved knowledge and attitudes toward suicide, but most show no effects on actual suicidal behavior, with the important exception of three large RCTs-SOS, YAM, and GBG.

    “Systematic reviews of school based programs consistently indicate improved knowledge and attitudes toward suicide, but most show no effects on actual suicidal behavior, with the important exception of three large RCTs-Signs of Suicide (SOS), 152 Youth Aware of Mental Health (YAM), 153 and Good Behavior Game (GBG).154”
    Quote in the paperSubstantial claim1 of 1 sources checked

  • May combine two claims.

    Premisecitation

    Evidence suggests that a few specific school based interventions can prevent suicidal ideation and suicide attempts, with moderate confidence in the effect estimates for both outcomes in the short term.

    “Efforts to prevent suicide in young people have been integrated into community settings such as schools 105 ; evidence suggests that a few specific school based interventions can prevent suicidal ideation and suicide attempts, with moderate confidence in the effect estimates for both outcomes in the short term.151”
    Quote in the paperSubstantial claim1 of 1 sources checked

  • May combine two claims.

    Premisecitation

    Early data suggest overall that the suicide rate is increasing with a disproportionate impact on minoritized young people in the US.

    “The longstanding impact of the covid-19 pandemic on suicide in young people is yet to be fully understood, but early data suggest overall that the suicide rate is increasing with a disproportionate impact on minoritized young people in the US.167”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [167] Curtin S, Garnett M, Ahmad F. Provisional numbers and rates of suicide by month and demographic characteristics: United States, 2021. 2022. https://stacks.cdc.gov/view/cdc/120830. source

      The Age-adjusted rates by demographic characteristics section reports that the overall US suicide rate rose 4% from 2020 to 2021, and the Discussion reports a significant increase among males aged 15–24. The report breaks rates down by age and sex, not race or ethnicity, so it does not support the claimed disproportionate impact on minoritized young people. Page numbers were not available in our copy. (LLM, conf=0.90)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Worldwide, suicide is the fourth leading cause of death among 15-19 year olds.

    “Worldwide, suicide is the fourth leading cause of death among 15-19 year olds.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] World Health Organization. Deaths by sex and age group for a selected country or area and year. https://platform.who.int/mortality/themes/theme-details/MDB/injuries.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingcitation

    This age related racial disparity has persisted through 2016-20 for pre-adolescents, although suicide rates remain higher in white than black young people after age 12 years.

    “this age related racial disparity has persisted through 2016-20 for pre-adolescents, although suicide rates remain higher in white than black young people after age 12 years (fig 3).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    In the US, suicide was the third leading cause of death among 15-19 year olds (2216 deaths) in 2020.

    “In the US, suicide was the third leading cause of death among 15-19 year olds (2216 deaths) in 2020”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] Centers for Disease Control and Prevention. Fatal Injury and Violence Data. https://www.cdc.gov/injury/wisqars/fatal.html.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingcitation

    American Indian/Alaska Native young people have the highest rates of suicide in the US, with age adjusted rates for 10-19 year olds (12.9 per 100 000) that are 1.9 times the rate for young white people (6.9 per 100 000) and more than two times higher than in young black (5.6 per 100 000), Asian/Pacific Islander (5.5 per 100 000), and Hispanic/Latinx people (5.3 per 100 000).

    “American Indian/Alaska Native young people have the highest rates of suicide in the US, 3 with age adjusted rates for 10-19 year olds (12.9 per 100 000) that are 1.9 times the rate for young white people (6.9 per 100 000) and more than two times higher than in young black (5.6 per 100 000), Asian/Pacific Islander (5.5 per 100 000), and Hispanic/Latinx people (5.3 per 100 000).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] Centers for Disease Control and Prevention. Fatal Injury and Violence Data. https://www.cdc.gov/injury/wisqars/fatal.html.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    In the US, suicide was the second leading cause of death among 10-14 year olds (581 deaths) in 2020.

    “and the second leading cause of death among 10-14 year olds (581 deaths).3”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] Centers for Disease Control and Prevention. Fatal Injury and Violence Data. https://www.cdc.gov/injury/wisqars/fatal.html.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    A meta-analysis using the World Health Organization's mortality database from 45 mostly high income and middle income countries identified the lowest suicide rate among people aged 10-19 years in Israel (1.31/100 000) and the highest in Estonia (9.72/100 000).

    “A recent meta-analysis using the World Health Organization's mortality database from 45 mostly high income and middle income countries identified the lowest suicide rate among people aged 10-19 years in Israel (1.31/100 000) and the highest in Estonia (9.72/100 000).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    Recent statistics document more guns than people in the US (393 million guns versus 326 million people: ratio=126 guns per 100 people), with US firearm ownership rates more than sixfold higher than the average of similar wealthy nations.

    “Recent statistics document more guns than people in the US (393 million guns versus 326 million people: ratio=126 guns per 100 people), with US firearm ownership rates more than sixfold higher than the average of similar wealthy nations.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Ingraham C. There are more guns than people in the United States, according to a new study of global firearm ownership. 2018. https://www.washingtonpost.com/news/wonk/wp/2018/06/19/there-are-more-guns-than-people-in-the-united-states-according-to-a-new-study-of-global-firearm-ownership/.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingcitation

    Hanging/suffocation is the most common method of suicide among young people worldwide, followed by jumping from a height or jumping/lying in front of a moving object.

    “Hanging/suffocation is the most common method of suicide among young people worldwide, followed by jumping from a height or jumping/lying in front of a moving object.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingcitation

    The US had the seventh highest rate of suicide in young people (5.91/100 000) and the UK the seventh lowest (2.35/100 000).

    “By comparison, the US had the seventh highest rate of suicide in young people (5.91/100 000) and the UK the seventh lowest (2.35/100 000).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] source

  • May combine two claims.

    Findingcitation

    Suicide is rare before the age of 10 years, with suicide rates thereafter increasing with age throughout adolescence.

    “Suicide is rare before the age of 10 years, with suicide rates thereafter increasing with age throughout adolescence (fig 2).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] Centers for Disease Control and Prevention. Fatal Injury and Violence Data. https://www.cdc.gov/injury/wisqars/fatal.html.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingcitation

    In the US, firearms are the most common suicide method among young people, accounting for 43.6% of all deaths by suicide among 10-19 year olds between 2016 and 2020, followed by hanging/suffocation (42.7%) and self-poisoning (6.8%).

    “By contrast to most other countries, firearms are the most common suicide method among young people in the US, accounting for 43.6% of all deaths by suicide among 10-19 year olds between 2016 and 2020, followed by hanging/suffocation (42.7%) and self-poisoning (6.8%).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] Centers for Disease Control and Prevention. Fatal Injury and Violence Data. https://www.cdc.gov/injury/wisqars/fatal.html.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Nearly 20% of all deaths in young people in the US in 2020 were from suicide.

    “nearly 20% of all deaths in young people in the US in 2020 were from suicide, 3 warranting attention in the primary care setting.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] Centers for Disease Control and Prevention. Fatal Injury and Violence Data. https://www.cdc.gov/injury/wisqars/fatal.html.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingcitation

    The period immediately following discharge from an inpatient psychiatric hospital or an emergency department visit for suicidal or self-harm behavior poses an extremely high risk of suicide and repeat suicidal/self-harm behavior in young people.

    “The period immediately following discharge from an inpatient psychiatric hospital or an emergency department visit for suicidal or self-harm behavior poses an extremely high risk of suicide and repeat suicidal/self-harm behavior in young people.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [53] source
    • cites [54] source

  • Classified as probably not a substantial claim. May combine two claims.

    Findingcitation

    The NICE Guideline Committee determined that risk assessment measures cannot accurately predict risk of suicide or self-harm and that the potential harms of risk stratification outweigh any benefits, partly because of the dynamic nature of suicide risk but also because people who die by suicide often score low on these risk scores.

    “The NICE Guideline Committee determined that risk assessment measures cannot accurately predict risk of suicide or self-harm and that the potential harms of risk stratification outweigh any benefits, partly because of the dynamic nature of suicide risk but also because people who die by suicide often score low on these risk scores.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [98] National Institute for Health and Care Excellence. Self-harm: assessment, management, and preventing recurrence. 2022. https://www.nice.org.uk/guidance/ng225.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Findingcitation

    Family support significantly reduced the association between intersecting marginalized identities and suicidality, framing a potential target for intervention.

    “Family support significantly reduced the association between intersecting marginalized identities and suicidality, framing a potential target for intervention.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [46] source

  • May combine two claims.

    Findingcitation

    Many young people at risk for suicide receive inadequate care and fail to access evidence based, suicide focused intervention.

    “but many young people at risk for suicide receive inadequate care and fail to access evidence based, suicide focused intervention.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [99] source
    • cites [100] source

  • May combine two claims.

    Findingcitation

    Common elements of effective interventions include comprehensive assessment to inform treatment, safety planning, family involvement, coping skills training to match the needs identified in the assessment, and promotion of continuity of care.

    “Common elements of effective interventions include comprehensive assessment to inform treatment, safety planning, family involvement, coping skills training to match the needs identified in the assessment, and promotion of continuity of care.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [131] Substance Abuse and Mental Health Services Administration (SAMHSA). Treatment for Suicidal Ideation, Self-harm, and Suicide Attempts Among Youth. 2020. https://store.samhsa.gov/sites/default/files/pep20-06-01-002.pdf.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    The UK NICE guidelines recommend against stratification of suicide risk, whereas Joint Commission guidelines in the US endorse determining individuals' level of suicide risk and a plan to mitigate that risk.

    “The UK NICE guidelines recommend against stratification of suicide risk, whereas Joint Commission guidelines in the US endorse determining individuals' level of suicide risk and a plan to mitigate that risk.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Emotion focused, more avoidant coping strategies are associated with increased deliberate self-harm, while problem focused coping may be protective.

    “Because emotion focused, more avoidant coping strategies are associated with increased deliberate self-harm, problem focused coping may be protective.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [110] source

  • May combine two claims.

    Findingcitation

    Dialectical behavioral therapy (DBT) for adolescents is the only intervention that meets criteria for a well established treatment, with two RCTs showing efficacy in reducing suicide risk.

    “Dialectical behavioral therapy (DBT) for adolescents is the only intervention that meets criteria for a well established treatment, with two RCTs showing efficacy in reducing suicide risk.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [129] source

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    This review is based on a comprehensive examination of studies published in English and cited in PubMed and PsycInfo between 1 January 2000 and 15 March 2022, as well as selected seminal papers extracted from reference lists of identified articles.

    “This review is based on a comprehensive examination of studies published in English and cited in PubMed and PsycInfo between 1 January 2000 and 15 March 2022, as well as selected seminal papers extracted from reference lists of identified articles.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Articles were included if two authors deemed them relevant to the review.

    “an article was included if two authors deemed it relevant to the review (n=14).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    This review focused on suicide in young people in the US but included a discussion of international guidelines on suicide in young people published during the time period.

    “Although this review is focused on suicide in young people in the US, we included a discussion of international guidelines on suicide in young people published during this time period.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims. The quote only partly states this claim.

    Study design and conductown data

    Two authors and two research associates did the searches; the same two authors reviewed and summarized each collected article and determined the most relevant to include, with another author reviewing disagreements.

    “Two authors (JLH, JAB) and two research associates did the searches.The same two authors reviewed and summarized each collected article and then determined the most relevant to include in this review, on the basis of topical relevance and clinical relevance.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    The review prioritized systematic reviews and meta-analyses over individual studies, randomized controlled trials over non-randomized controlled and quasiexperimental designs, large studies over studies with smaller sample sizes, and studies published recently over older studies.

    “We prioritized systematic reviews and meta-analyses over individual studies, randomized controlled trials (RCTs) over non-randomized controlled and quasiexperimental designs, large studies over studies with smaller sample sizes, and studies published recently over older studies.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationreasoning

    Equity may be a consideration in universal screening, as screening all patients who meet criteria set by the system eliminates clinician bias and may reduce barriers to access to healthcare.

    “Equity may be a consideration in universal screening, as screening all patients who meet criteria set by the system eliminates clinician bias and may reduce barriers to access to healthcare.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Some states in the US are now mandating that primary care providers screen for suicide risk.

    “Some states in the US are now mandating that PCPs screen for suicide risk.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [90] Levesque B. Newsom Signs Legislation Requiring Suicide Screening at Hospitals. 2022. https://www.losangelesblade.com/2022/07/19/newsom-signs-legislation-requiring-suicide-screening-at-hospitals/.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Premisecitation

    The UK National Institute for Health and Care Excellence (NICE) recommends against stratification of suicide risk into low, medium, or high to determine who should be offered treatment or discharged from hospital or to predict future individual risk of suicide or self-harm.

    “By comparison, the UK National Institute for Health and Care Excellence (NICE) recommends against stratification of suicide risk into low, medium, or high to determine who should be offered treatment or discharged from hospital or to predict future individual risk of suicide or self-harm.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [98] National Institute for Health and Care Excellence. Self-harm: assessment, management, and preventing recurrence. 2022. https://www.nice.org.uk/guidance/ng225.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In February 2022, Bright Futures/American Academy of Pediatrics recommended screening for suicide risk in young people aged ≥12 years as part of its preventive care periodicity schedule.

    “In February 2022, Bright Futures/American Academy of Pediatrics recommended screening for suicide risk in young people aged ≥12 years as part of its preventive care periodicity schedule.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [89] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The American Academy of Pediatrics and the American Foundation for Suicide Prevention created the 2022 Blueprint for Youth Suicide Prevention.

    “the American Academy of Pediatrics and the American Foundation for Suicide Prevention created the 2022 Blueprint for Youth Suicide Prevention.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [91] American Academy of Pediatrics. Suicide: Blueprint for Youth Suicide Prevention. https://www.aap.org/suicideprevention.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisenone given

    In the US, the Joint Commission recommends determining level of suicide risk, such as low, medium, and high, and formulating a care plan to tackle and reduce risk.

    “In the US, the leading hospital accreditation body, the Joint Commission, recommends determining level of suicide risk, such as low, medium, and high, and formulating a care plan to tackle and reduce risk.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Evidence of the importance of family involvement in treatment for suicidal young people is growing, although few studies have included specific family focused outcome variables.

    “Evidence of the importance of family involvement in treatment for suicidal young people is growing, although few studies have included specific family focused outcome variables.130 148”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites 130 148

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    In a long term follow-up, counties exposed to the Garrett Lee Smith Memorial Act program during a single year had suicide mortality rates in young people estimated to be 0.9 per 100,000 lower than control counties one year after implementation and 1.1 per 100,000 lower two years after.

    “In a long term follow-up, counties exposed to this program during a single year had suicide mortality rates in young people estimated to be 0.9 per 100 000 lower than control counties (P=0.03)one year after the implementation and 1.1 per 100 000 lower than control counties (P=0.01)two years after the implementation.150”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [150] source

  • May combine two claims.

    Premisecitation

    Very little has been published about the effectiveness of suicide prevention interventions in low-middle income countries internationally, with only one study evaluating suicidal ideation outcomes in adolescents.

    “Very little has been published about the effectiveness of suicide prevention interventions in low-middle income countries internationally, with only one study evaluating suicidal ideation outcomes in adolescents.144”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [144] source

  • May combine two claims.

    Premisecitation

    At the 12 month follow-up, young people participating in YAM reported significantly reduced suicidality, including 55% fewer incident suicide attempts and 50% fewer cases of severe suicidal ideation, compared with controls.

    “At the 12 month follow-up, those young people participating in YAM reported significantly reduced suicidality, including 55% fewer incident suicide attempts and 50% fewer cases of severe suicidal ideation, compared with controls.153”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [153] source

  • May combine two claims.

    Premisecitation

    In multiple RCTs, SOS led to a 40-64% reduction in student self-reported suicide attempts, greater knowledge of depression and suicide, and more adaptive attitudes toward these matters.

    “In multiple RCTs, SOS led to a 40-64% reduction in student self-reported suicide attempts, greater knowledge of depression and suicide, and more adaptive attitudes toward these matters.152 155 156”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites 152 155 156

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

52 of 52

  • The paper relies on this without support.

    Suicide in young people is preventable through improved identification, prevention, and treatment strategies.

    “Suicide in young people is a global public health problem, and improved identification, prevention, and treatment strategies are imperative.”

  • The paper relies on this without support.

    Screening for suicide risk can identify young people at high risk.

    “Screening for suicide risk involves use of an evidence based, standardized screening measure to identify young people with suicidal ideation or behavior and can be accomplished at the universal, selective, or indicated level.”
2 of 2

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

  • Guns-per-person ratio does not match the stated counts

    Minor

    The stated counts imply about 121 guns per 100 people, not 126.

    Reported 126 · recomputed 120.552147

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 3

  1. Joiner TE Jr . Why people die by suicide. Harvard University Press, 2005.
  2. 10.1016/j.jaac.2020.09.013 · DOI · Paper page
  3. Feasibility of comparing dialectical behavior therapy with treatment as usual for suicidal and self-injuring adolescents: Follow-up data from a small randomized controlled trial. AL Miller (Chair), Symposium presented at the annual meeting of the Association of Behavioral and Cognitive Therapies, National Harbor, MD; 2012.

Cited by

Sorted by citations

Related

Authors
Hughes, J. L., Horowitz, L. M., Ackerman, J. P., Adrian, M. C., Campo, J. V., & Bridge, J. A.
Affiliations
  • Nationwide Children's Hospital (US)
  • National Institutes of Health (US)
  • University of Washington (US)
  • Johns Hopkins University (US)
  • The Ohio State University Wexner Medical Center (US)
Corresponding author
Hughes, Jennifer L
ORCID
Venue
BMJ
Publisher
BMJ
Published
2023-04-24
Volume
381
Pages
e070630
ISSN
1756-1833 (ISSN-L)
DOI
10.1136/bmj-2022-070630
PMC
PMC11741005
OpenAlex
W4366823295
Cited by
135
References
157
Citations by year
2026: 36 · 2025: 48 · 2024: 44 · 2023: 7
FWCI
6.85
Type
journal article
Language
en
Open access
Licence
www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
Locations
  • BMJ (publishedVersion)
  • PubMed Central (publishedVersion, public-domain)
  • PubMed (publishedVersion)
Funders
  • U.S. Department of Health and Human Services
  • Patient-Centered Outcomes Research Institute
  • National Institutes of Health
  • Centers for Disease Control and Prevention
  • Substance Abuse and Mental Health Services Administration
  • National Institute of Mental Health (P50MH127476, ZIAMH002922, P50MH129708)
  • Center for Mental Health Services
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 risk assessment, suicide risk screening, suicide prevention, intersectionality, suicide epidemiology, suicidal behavior, psychosocial interventions, evidence-based interventions, community-based prevention
MeSH terms
Suicide Prevention, Adolescent, Humans, Suicide, Risk Assessment, Suicidal Ideation

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

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