Comparing frequencies of adolescent suicide attempters pre- and during COVID-19 pandemic school terms.

BACKGROUND: The COVID-19 pandemic had and still have a major impact on adolescent mental health and consequently on suicidal behavior. However, few studies have investigated whether the pandemic has changed the patterns and the triggers of suicidality peaks in adolescents, e.g., seasonal patterns or family conflicts. We hypothesized that the pandemic modified suicidality rates: an increment of suicide attempts would be observed in the first semester of the academic year during COVID-19 pandemic compared to the same period of previous academic year; and the precipitating factors would be more related to social stressors during the pandemic school year. METHODS: A retrospective cross-sectional study was conducted to assess the precipitating factors, also including school-related factors and cognitive skills, of adolescent suicide attempters occurred in the first and second semesters of the year before the pandemic lockdown (study periods 1 and 2) and the year after (study periods 3 and 4). RESULTS: The sample consisted of 85 adolescents aged between 12 and 17 recruited consecutively from March 2019 to March 2021 at emergency ward because of suicide attempt. Forty-eight adolescents (55.3% of the sample) were attended before the lockdown (pre-pandemic group) and 38 (44.7%) the year after. The results showed a higher proportion of female suicide attempters in period 4 (Sept 2020-Feb 2021) respect to period 3 (Mar 2020-Aug 2020), i.e., pandemic semesters compared with the increment observed between period 2 and 1 (prepandemic semesters; Fisher's exact test = 4.73; p = 0.026). The multinomial regression models showed a significant effect in the frequency of adolescents who attempted suicide (ratio χ2 = 15.19, p = 0.019), accounted by the differences between period 4 (Sept 2020-Feb 2021) and period 1 (Mar 2019-Aug 2019), with depressive symptoms being a significant contributing factor (Exp(b) = 0.93; p = 0.04). Additionally, social triggers and age were found to be significant risk factors for suicide attempts in the first semester of the pandemic academic year (period 4) compared to the same semester of the pre-pandemic year (period 2; Exp(b) = 0.16, p = 0.01, and Exp(b) = 1.88, p = 0.006, respectively). CONCLUSIONS: During the pandemic, the decrement between first and second semester of the number of females attempting suicide was more pronounced than in the prepandemic school year -though this findings lacked statistical power due to very limited sample size-. Change in the frequency of adolescent attempting suicide in the different school periods was associated with greater severity of depressive symptoms. Social relations in back-to-school after the lockdown were also associated with the number of adolescents attempting suicide.

Unveiling Adolescent Suicidality: Holistic Analysis of Protective and Risk Factors Using Multiple Machine Learning Algorithms.

Adolescent suicide attempts are on the rise, presenting a significant public health concern. Recent research aimed at improving risk assessment for adolescent suicide attempts has turned to machine learning. But no studies to date have examined the performance of stacked ensemble algorithms, which are more suitable for low-prevalence conditions. The existing machine learning-based research also lacks population-representative samples, overlooks protective factors and their interplay with risk factors, and neglects established theories on suicidal behavior in favor of purely algorithmic risk estimation. The present study overcomes these shortcomings by comparing the performance of a stacked ensemble algorithm with a diverse set of algorithms, performing a holistic item analysis to identify both risk and protective factors on a comprehensive data, and addressing the compatibility of these factors with two competing theories of suicide, namely, The Interpersonal Theory of Suicide and The Strain Theory of Suicide. A population-representative dataset of 173,664 Norwegian adolescents aged 13 to 18 years (mean = 15.14, SD = 1.58, 50.5% female) with a 4.65% rate of reported suicide attempt during the past 12 months was analyzed. Five machine learning algorithms were trained for suicide attempt risk assessment. The stacked ensemble model significantly outperformed other algorithms, achieving equal sensitivity and a specificity of 90.1%, AUC of 96.4%, and AUCPR of 67.5%. All algorithms found recent self-harm to be the most important indicator of adolescent suicide attempt. Exploratory factor analysis suggested five additional risk domains, which we labeled internalizing problems, sleep disturbance, disordered eating, lack of optimism regarding future education and career, and victimization. The identified factors provided stronger support for The Interpersonal Theory of Suicide than for The Strain Theory of Suicide. An enhancement to The Interpersonal Theory based on the risk and protective factors identified by holistic item analysis is presented.

The prevalence of mental illness in young people in custody over time: a comparison of three surveys in New South Wales.

Few studies have examined the prevalence of mental illness in young people over time within the same jurisdiction. In the current study, we compared data from three large surveys of youth in custody in New South Wales, conducted in 2003, 2009 and 2015. We examined rates of mental illness, self-harm and suicidal behaviours, substance use and childhood trauma and found little consistent change over time, though some fluctuations were observed regarding certain mental illnesses and substance use. We also descriptively compared findings with observed rates for the general population and found that young people in custody showed higher levels of all examined variables. In sum, these data suggest little improvement in the well-being of young people in custody in New South Wales over time. Better identification and treatment of these issues are vital if young people are to be prevented from becoming enmeshed in the criminal justice system.

Correlates for Suicidality Among At-risk Youth Receiving Community-Based Mental Health Services.

"At-risk" adolescents are at high risk of unsuccessfully transitioning into adulthood and are also at elevated risk for suicidal behavior. Though much research has been conducted on risk factors for suicidality among the general adolescent population, research on suicidality among "at-risk" adolescents is lacking. This is a notable gap in the literature given that "at-risk" adolescents may be three times more likely to exhibit suicidality. The present study addressed this research gap by examining correlates for suicidality among "at-risk" adolescents receiving mental health services in the community. Using Electronic Health Record (EHR) data, risk factors for suicidality were analyzed at the bivariate and multivariate levels. Sexual abuse was a significant predictor of suicidality, as well as impulsivity for suicide attempt only. These findings may serve as useful adjuncts in the design of suicidality-screening tools and follow-up practices within the context of community-based mental health organizations which target at-risk adolescents.

Practice-based insights from specialized clinicians into youth suicide risk assessment and psychotherapy: A qualitative study.

Objective: The experience of frontline clinicians is an underutilized source of knowledge about improving youth suicide intervention. This qualitative study explored the perspectives of highly experienced, specialized mental health clinicians on the practical application of risk assessment, stabilization, and treatment and their experience of working in this practice area.Method: Data were collected from seven focus groups with 28 clinicians and analyzed using consensual qualitative research methods.Results: Four domains emerged, describing 1) youth suicide intervention as relationally focused and attachment-informed, 2) the need for flexible and tailored care balancing individual and family intervention in the context of family complexity and fractured relationships, 3) a nuanced, therapeutic approach to managing the complexity and uncertainty of adolescent suicide risk, and 4) working in youth suicide intervention as emotionally demanding and facilitated or hampered by the organizational and systems context.Conclusion: The importance of harnessing family systems and attachment-informed approaches to alliance, risk assessment, and treatment was emphasized, along with the parallel need for systemic clinician support and consideration of the potential negative consequences of administrative and risk management protocols.

Adolescent Suicide Risk Screening: A Secondary Analysis of the SHIELD Randomized Clinical Trial.

OBJECTIVE: To evaluate the effectiveness of adolescent suicide risk screening to increase initiation of mental health services via a secondary analysis using data from the SHIELD (Screening in High Schools to Identify, Evaluate and Lower Depression) randomized clinical trial, which evaluated school-based screening for major depressive disorder (MDD). STUDY DESIGN: Students in 14 Pennsylvania high schools were randomized by grade to either the usual school practice of targeted referral for behavior raising a concern for suicide risk or universal screening using the Patient Health Questionnaire-9 (PHQ-9), with any response >0 to item 9 regarding suicide risk considered positive. Students identified in either arm were referred to the Student Assistance Program (SAP), which is mandated in all Pennsylvania schools. The SAP determined follow-up. Study groups were compared using mixed-effects logistic regression. RESULTS: The participants comprised 12 909 students, with 6473 (50.1%) randomized to universal screening. The study group was 46% female and 43% Hispanic or non-Hispanic Black. Adolescents in the universal screening arm had 7.1-fold greater odds (95% CI, 5.7-8.8) of being identified as at risk for suicide, 7.8-fold greater odds (95% CI, 4.6-13.1) of follow-up needs, and 4.0-fold greater odds (95% CI, 2.0-7.9) of initiating mental health treatment. CONCLUSIONS: Although the PHQ-9 is a MDD screening tool, its use in universal screening increased identification and treatment initiation for adolescents at risk for suicide. This confirms the value of universal screening and suggests that a suicide-specific risk assessment would have even greater impact on treatment initiation for identified youth. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03716869.

Lessons Learned to Building Stakeholder Engagement during the Initial Stages of Pragmatic Research Development and Implementation.

Research does not occur in a vacuum. Effective stakeholder engagement occurs on several levels, including outside influence and cooperation inside the institution. Little guidance around designing and implementing pragmatic mental health research exists. The following paper outlines lessons learned during the initial stages of research design and implementation for a project focused on mental health treatment outcomes.

Emerging Despite the Indelible Wound: A Grounded Theory of Family Transformation Following Adolescent Suicide.

Family members of a person who has died by suicide are at an increased risk of experiencing depression, post-traumatic stress disorder, suicide ideation, and suicide. However, despite the experience of losing a family member to suicide, most families continue to function and even live well following this difficult experience. This study sought to understand and describe the transformation process that occurs in family member survivors using a grounded theory approach. Seven families, who experienced the loss of an adolescent in their family by suicide, participated in this qualitative study that used a grounded theory methodology. The results describe the transformation process experienced by the family, one of growth and learning, even though the wound from their tragic loss was still present. According to the grounded theory developed in this study, the suicide is a cataclysm, followed by a sinking period that is tempered by the presence of lifebuoys, which are supports that can be found within the families or from people around them. It is necessary for family nurses to understand this transformation process to better support surviving family members and improve suicide postvention care.

Characteristics of interpersonal conflicts preceding youth suicide: analysis of data from the 2017 National Violent Death Reporting System.

BACKGROUND: Deaths by suicide among US adolescents aged 10 to 19 increased by more than 85% between 2007 and 2017. Interpersonal conflicts with peers or family members, in combination with biological, psychological, and cognitive attributes of adolescents, are among risk factors. More insight about contextual factors, including timing of conflicts relative to suicide, would be useful for professionals and programmers. METHOD: We used data from the 2017 National Violent Death Reporting System (NVDRS) reflecting most cases in 37 US states to explore contextual circumstances in adolescent death by suicide preceded by interpersonal conflicts. We calculated descriptive statistics and conducted content analysis of narratives to identify attributes of 197 cases. RESULTS: Most deaths by suicide (n = 155) occurred within 24 hr of the conflict; most conflicts involved the adolescent and family members (n = 138). When subject matter was described, most conflicts (n = 27) focused on concerns with an adolescent's behavior. Nearly a quarter of cases (n = 49) involved technology, including technology restrictions as punishment, as either a primary or additional aspect of the conflict. CONCLUSIONS: Our findings provide support for prior research suggesting links between technology and mental health concerns, including suicidality, among adolescents. While previous works have identified both positive and negative aspects of the use of technology by adolescents, our findings suggest that restriction of technology as a punishment may be an additional contextual factor of interest in a proportion of youth suicides preceded by an argument. Given ongoing regular use of technology, practitioners should address these potential risk factors regardless of risk status.

Exposure to suicide behaviour and individual risk of self-harm: Findings from a nationally representative New Zealand high school survey.

PURPOSE: To examine whether there is an association between students self-reported suicide attempts and non-suicidal self-injury and exposure to suicidal behaviour among friends, family members or within school communities. METHODS: A cross-sectional analysis of a nationally representative health and well-being survey of 8500 New Zealand high school students conducted from March through November 2012. Students' self-reported suicide attempts and repeated non-suicidal self-injury was examined in relation to student reports of self-harming behaviour among friends and family as well as data from school administrators of completed suicides within the school community. RESULTS: Almost 1 in 20 (4.5%) students reported a suicide attempt in the last 12 months and 7.9% reported repeated non-suicidal self-injury in the last 12 months. The risk of both suicide attempts and repeated non-suicidal self-injury was highest among females, students from homes with economic deprivation and among students reporting an episode of low mood in the previous 12 months. Students exposed to suicide attempts or completed suicide among friends and/or family members were at increased risk of reporting attempted suicide and repeated non-suicidal self-injury in the last year. There was no association between completed suicide in school community and students self-reported suicide attempts or repeated non-suicidal self-injury. CONCLUSIONS: Low mood and exposure to suicide attempts of friends and family members are associated with suicide attempts and repeated non-suicidal self-injury in New Zealand high school students. This research highlights importance of supporting adolescents with low mood and exposed to suicide of friends and family.

Suicide Risk Screening in Healthcare Settings: Identifying Males and Females at Risk.

Suicide is the tenth leading cause of death in the United States, accounting for more than 42,000 deaths in 2014. Although this tragedy cuts across groups defined by age, gender, race/ethnicity, and geographic location, it is striking that nearly four times as many males as females die by suicide in the U.S. We describe the current regulations and recommendations for suicide risk screening in healthcare systems and also describe the aspirational goal of "Zero Suicide," put forth by the National Action Alliance for Suicide Prevention. We then provide information about suicide risk screening tools and steps to take when a patient screens positive for suicide risk. Given the substantially higher suicide rate among males than females, we argue that it is important to consider how we could optimize suicide risk screening strategies to identify males at risk and females at risk. Further research is needed to accomplish this goal. It is recommended that we consider multi-factorial suicide risk screens that incorporate risk factors known to be particularly important for males as well as computerized, adaptive screens that are tailored for the specific risk considerations of the individual patient, male or female. These strategies are not mutually exclusive. Finally, universal suicide risk screening in healthcare settings, especially primary care, specialty medical care, and emergency department settings, is recommended.

Collaborative strategies for adolescent suicide prevention: insights from Slovakia and Kyrgyzstan.

OBJECTIVE: The study aimed to gain insights about the collaborative efforts of various professionals involved in preventing adolescent suicide within multidisciplinary teams in Slovakia and Kyrgyzstan. MATERIALS AND METHODS: A qualitative research method was employed, involving semi-structured interviews with 10 specialists from Slovakia and Kyrgyzstan. RESULTS: Despite differing levels of development and implementation of multidisciplinary team concepts, findings revealed a generally positive impact of collaborative efforts in both countries (more structured in Slovakia and less developed in Kyrgyzstan). Multidisciplinary teams in educational settings strive to create supportive environments for adolescents, contributing significantly to mitigating various issues during their formative years. CONCLUSIONS: Prevention efforts require coordinated action among multiple social institutions with unified strategies. While progress has been made, there remains potential for further development, particularly in improving cooperation among specialists, national recognition of youth suicide as a critical issue, and institutionalizing procedures to elevate the status and education of multidisciplinary teams. SIGNIFICANCE: This research provides innovative insights into the effectiveness of multidisciplinary teams in suicide prevention among adolescents. By suggesting comprehensive strategies for team collaboration, it offers valuable contributions to reducing youth suicide rates in both Slovakia and Kyrgyzstan.

Trajectory of suicide among Indian children and adolescents: a pooled analysis of national data from 1995 to 2021.

BACKGROUND: Suicide is a major public health concern in India especially among children and adolescents. The yearly national statistics show a concerning trend of rising suicide deaths in these age groups. METHODS: The present study, taking 26 years of national data from the National Crime Record Bureau during 1995-2021, examined the trend, patterns, means, and modes of children/adolescent suicides in India. We also undertook a time series analysis by using ARIMA (0,2,1) model to forecast the expected suicide rate for the next one decade. RESULTS: A rising trend of suicide rate among children and adolescents was observed in India over the last 26 years. The forecast indicates a continuance of rising suicide cases for the upcoming decade in India. A substantially different trend of suicide rate was observed among early and late adolescents indicating significantly high vulnerability of late adolescents. Among children /adolescents, the most common causes of suicide were family problems, academic failure, illness, and unemployment. Illness has emerged as one of the leading causes of suicide, with a significant rise over time. Poverty and unemployment were also found as the important contributors with a steadily increasing trend of suicide among children and adolescents facing these problems in recent years. CONCLUSION: The study provides important analysis and information on suicide among children/adolescents in India, by providing useful insights for parents, teachers, policymakers, healthcare practitioners, and stakeholders aiming to prevent and control children and adolescent suicide and boost mental health. The study also provides important leads on risk factors with a forecast of suicide trends for the next 10 years.

Testing the Impact of a Law Enforcement-Operated Co-responder Program for Youths: A Quasi-Experimental Approach.

OBJECTIVE: The authors examined whether use of a co-responder program reduced the likelihood of an involuntary commitment examination as the disposition of a police encounter with youths experiencing a mental health crisis and 1 year after the initial incident. METHODS: Using a quasi-experimental design, the authors compared 206 incidents that involved the co-response program with 327 incidents that did not involve the program. Propensity score matching was used to balance groups on demographic and incident characteristics. The dependent variables included the disposition of the incident (deescalation or involuntary commitment examination), whether the youths experienced a later involuntary commitment examination within 1 year of the initial intervention, and time to the subsequent examination. Propensity score-weighted binary logistic regression and time-to-event analysis were used. RESULTS: The co-responder program was associated with a significantly lower likelihood of police officer-initiated involuntary commitment examinations and a lower likelihood of an involuntary commitment examination within 1 year. Eighty percent of the incidents that resulted in a co-response involving a police officer and a mental health professional were deescalated, allowing the youth to remain in the community with a safety plan, whereas 17% of incidents with a police-only response ended with crisis deescalation. CONCLUSIONS: These findings provide further support for the implementation of co-responder options that are available to police officers during encounters with children and adolescents experiencing a mental health crisis.

Adolescent suicide risk factors and the integration of social-emotional skills in school-based prevention programs.

Adolescents are considered one of the most vulnerable groups affected by suicide. Rapid changes in adolescents' physical and mental states, as well as in their lives, significantly and undeniably increase the risk of suicide. Psychological, social, family, individual, and environmental factors are important risk factors for suicidal behavior among teenagers and may contribute to suicide risk through various direct, indirect, or combined pathways. Social-emotional learning is considered a powerful intervention measure for addressing the crisis of adolescent suicide. When deliberately cultivated, fostered, and enhanced, self-awareness, self-management, social awareness, interpersonal skills, and responsible decision-making, as the five core competencies of social-emotional learning, can be used to effectively target various risk factors for adolescent suicide and provide necessary mental and interpersonal support. Among numerous suicide intervention methods, school-based interventions based on social-emotional competence have shown great potential in preventing and addressing suicide risk factors in adolescents. The characteristics of school-based interventions based on social-emotional competence, including their appropriateness, necessity, cost-effectiveness, comprehensiveness, and effectiveness, make these interventions an important means of addressing the crisis of adolescent suicide. To further determine the potential of school-based interventions based on social-emotional competence and better address the issue of adolescent suicide, additional financial support should be provided, the combination of social-emotional learning and other suicide prevention programs within schools should be fully leveraged, and cooperation between schools and families, society, and other environments should be maximized. These efforts should be considered future research directions.

Perceptions of key stakeholders on peer led strength building program for suicide prevention among young adolescents: A qualitative study from Karnataka, India.

Context: Adolescent suicides are a significant public health concern in India and understanding the intersecting perspectives becomes imperative for the prevention of various mental health concerns. Aim: Assessing perceptions of various key stakeholders, that is, mental health experts, school and college teachers, and District Mental Health Program staff about peer-led strength building programs for suicide prevention. Settings and Design: A cross-sectional qualitative design using two Focus Group Discussions (FGDs) with mental health experts and teachers and one FGD with DMHP staff was conducted. The sample comprised 45 participants from Bengaluru urban district. Materials and Methods: The data were analyzed manually by the method of direct content analysis, and themes were determined using existing literature. Results: The teachers and the DMHP highlighted the need for an intensive training program/module that is necessary to be developed in order to train the peer leaders first. The mental health experts opined that creating a network will help in easy identification of the cases and appropriate treatment could be provided without delays. Conclusions: This study indicated that suicide is a preventable public health emergency and inaccessibility to existing as well as proper support systems was perceived as a major concern. Therefore, peer-led programs are beneficial in steering and improving help seeking behavior in suicidal adolescents.

Integrated behavioral health services in pediatric primary care and emergency department utilization for suicide risk.

Introduction: Universal screening for suicide risk in primary care settings is a promising avenue for preventing self-harm and improving health outcomes. Triaging youth to an appropriate level of care, including diverting lower-risk patients from the emergency department (ED) is a meaningful goal. Previous research indicates integrated behavioral health (IBH) may prevent unnecessary admission to the ED on the day of suicide risk screening. We hypothesized that youth who received an IBH consultation the same day as suicide risk screening would be less likely to be admitted to the ED, but more likely to contact IBH services and utilize primary care in the following month. Methods: We conducted a retrospective chart review of 3,649 youth aged 10-18 years who were screened with the Ask Suicide-Screening Questions (ASQ) in two pediatric primary care practices. We collected demographic data, ASQ and Patient Health Questionnaire-9 (PHQ-9) scores, as well as patient contacts with IBH, the ED, and medical primary care the day of screening and the following 31 days. We conducted a series of logistic regressions and chi-square analyses to determine whether contact with IBH on the same day as positive suicide risk screenings predicted same-day admission to the ED, IBH contact, and medical primary care utilization. Results: Among the 7,982 ASQ scores, 1,380 (18%) were non-acute and 87 ASQs (1%) screened acutely positive. Over 90% of positive screens were diverted from the ED regardless of IBH contact. None of the patients died from suicide. Same-day IBH was associated with higher likelihood of general ED visits for all positive screens (acute and non-acute together). None of the positive screens that received an IBH consultation on the same day as screening were admitted to the ED in the subsequent month. Contact with IBH the same day as screening positively predicted utilization of IBH and medical primary care services in the subsequent month, especially for youth with minority race and ethnicity identities. Discussion: In the context of clinics with IBH and systematic risk assessment processes, most youth who screen positive for suicide risk are diverted from the ED. However, contrary to our hypothesis, our study showed that youth who received same-day IBH consultations were more likely to be admitted to the ED compared to peers who did not receive IBH consultations. These findings suggest that systematic suicide screening combined with IBH consultations in pediatric primary care can effectively identify risk levels and triage patients to appropriate care.

COVID-19 Pandemic Has Changed the Psychiatric Profile of Adolescents Attempting Suicide: A Cross-Sectional Comparison.

The COVID-19 pandemic is having a major impact on the mental health of adolescents, leading to suicidal behaviors. However, it remains to be clarified whether the COVID-19 pandemic has changed the psychiatric profile of adolescent suicide attempters. METHODS: a retrospective observational analytical study was conducted to assess age, gender and clinical characteristics of adolescents attempting suicide during the year before and the year after the global lockdown. RESULTS: ninety adolescents (12-17 y.o.) were recruited consecutively from February 2019 to March 2021 at the emergency ward for having attempted suicide. Fifty-two (57.8%) attended before the lockdown (pre-pandemic group) and thirty-eight (42.2%) the year after (pandemic group). There were significant differences in diagnostic categories between the periods (p = 0.003). Adjustment and conduct disorders were more frequent in the pre-pandemic group, while anxiety and depressive disorders were more prevalent during the pandemic. Although the severity of suicide attempts did not show significant differences between the two study periods (0.7), the generalized linear model showed that the suicide attempt severity was significantly associated with current diagnosis (p = 0.01). CONCLUSIONS: the psychiatric profile of adolescents attempting suicide was different before and during the COVID-19 pandemic. During the pandemic, the proportion of adolescents with a prior psychiatric history was lower, and most of them were diagnosed with depressive and anxiety disorders. These diagnoses were also associated with a greater severity in the intentionality of suicide attempt, regardless of the study period.

Corporal punishment bans and adolescent suicide rates: An international ecological study.

BACKGROUND: Exposure to corporal punishment during childhood is associated with suicidal behaviors during adolescence. To date, the protective effects of national policies governing the use of corporal punishment have rarely been studied for adolescent suicide outcomes. OBJECTIVE: To investigate contemporaneous and lagged associations between national legislation banning corporal punishment and adolescent suicide rates. PARTICIPANTS AND SETTING: We used population-level administrative and mortality data from 97 countries spanning the years 1950 to 2017. METHODS: Negative binomial models were used to investigate the relationship between the existence of official corporal punishment bans in countries and national adolescent suicide mortality rates and the potential time lag between the enactment of such bans and reductions in adolescent suicide rates. RESULTS: National policies that permitted corporal punishment in all settings (homes, schools, daycares, and alternative care) were associated with a higher relative risk (RR) for suicide in females aged 15-19 (RR = 2.07, p = .03), as were policies allowing corporal punishment in schools specifically (RR = 2.01, p = .02). Partial bans of corporal punishment and bans of school corporal punishment showed lagged effects on suicide rates which peaked after 12 years for females aged 15-19 and after 13 years for males aged 15-19. CONCLUSIONS: Study findings add to a body of evidence that suggests that official policies banning corporal punishment may promote adolescent health and well-being. The benefits of such policies in terms of reduced risk for adolescent suicide appear to peak approximately 12 to 13 years after enactment of the legislation.

Circumstances Contributing to Suicide Among U.S. Adolescents Aged 10-19 Years With and Without a Known Mental Health Condition: National Violent Death Reporting System, 2013-2018.

PURPOSE: Suicide is the second leading cause of death for adolescents in the United States; however, suicide is preventable and a better understanding of circumstances that contribute to death can inform prevention efforts. While the association between adolescent suicide and mental health is well established, multiple circumstances contribute to suicide risk. This study examines characteristics of adolescents who died by suicide and differences in circumstances between those with and without known mental health conditions at the time of death. METHODS: Logistic regression models were used to estimate adjusted odds ratios and 95% confidence intervals of circumstances contributing to suicide between decedents with and without known mental health conditions using data from the 2013 to 2018 National Violent Death Reporting System (analyzed in 2021). RESULTS: Decedents with a known mental health condition were 1.2-1.8 times more likely to experience problematic alcohol misuse, substance misuse, family and other nonintimate relationship problems, and school problems; however, there were no significant differences between those with and without a known mental health condition for the preceding circumstances of arguments or conflicts, criminal or legal problems, or any crisis occurring within the two weeks prior to death. DISCUSSION: A comprehensive suicide prevention approach can address not only mental health conditions as a risk factor but also life stressors and other crises experienced among adolescents without known mental health conditions.