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DSM-IV-TR Diagnostic Criteria

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Suicidal ideation consists of thoughts of wishing to be dead or wishing to kill or inflict life-threatening harm on oneself. Suicide attempt refers to deliberate self-destructive action intended to kill oneself. Because the attempter's intention is often ambivalent, an assessment of severity of intent is a crucial part of clinical evaluation. Lethality, in contrast, refers to the actual likelihood that the attempt will cause death. The term “parasuicide” has been used to denote attempts at self-injury that are of low lethality and involve little or no wish to actually die, while deliberate self-cutting refers to non-lethal, usually repetitive self-cutting apparently motivated by feelings of tension, depersonalization, or emptiness, rather than a wish to die.

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Although mood disorders, psychosis, and substance abuse are potent risk factors for completed suicide, suicide attempts and ideation in children and adolescents can occur in a wide variety of disorders and psychopathological conditions.

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Suicidal ideation—thoughts of wishing to be dead, or to kill or inflict life-threatening harm on oneself

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Suicide attempt—deliberate self-destructive action intended to kill one self

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Lethality—likelihood that an attempt will cause death

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Parasuicide—low lethality attempts at self-injury that involve little or no wish to die

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Epidemiology

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Completed Suicide

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Completed suicide is rare in prepubertal children, with an annual rate in the US on the order of 0.6 per 100,000 for children age 5–14 in 2003. Completed suicide in adolescents, however, is the third leading causes of mortality in the U.S. in this otherwise generally healthy age group, and in 2003 accounted for the death of 7.3 teens, age 15–19, per 100,000. The most recent international data show a similar pattern of relatively low rates for youngsters age 5–14 (ranging from 0–2.4 per 100,000), with higher rates for youth age 15–24 (ranging from 2.4 to 33.1 per 100,000) (see Table 40–1). Although young male suicides substantially outnumber female suicides throughout much of the world, the pattern is reversed in rural parts of the developing world, such as India and China, perhaps due to ready access to lethal insecticides used in agriculture. Although variations in reporting practices make direct comparisons difficult, there are apparent wide international variations, with high rates of youth suicide associated with rapid political and economic changes, widespread gun availability, breakdown of traditional culture among indigenous peoples, and changes in the status of women. Reported youth suicide rates are low in many predominantly Muslim and Catholic countries.

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Table Graphic Jump Location
Table 40–1. Youth suicide rates per 100,000 in selected countriesa

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