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BACKGROUND

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Suicide is the second leading cause of death among all youth in the United States between 10 and 24 years old.1 Suicide rates have increased almost steadily from 1999 through 2014 for both males and females of all ages between 10–74 years old. The percent increase in suicide rates for females was greatest for those aged 10–14 years.2 A review of youth suicides in 2014 revealed the greatest number and percentage of death was among youth age 15 to 24 years old, with 5079 youths in this age group having died from suicide as compared with 425 children age 10–14 years.1

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Males continue to have higher rates of suicide, with 18.2% of male youth between 15 and 24 years old committing suicide in 2014 compared with 4.6% of females in the same age group.2 The most common means of suicide among youth 10 to 14 years old in 2010 were suffocation (56.1% males/77% females), firearms (37.8% males/13.8% females), and poisoning (2.8% males/5.7% females).3 The most common means of suicide among youth 15 to 24 years old were firearms (48.9% males/ 24.4% females), suffocation (37.4% males/49.9% females), and poisoning (6.2% males/16.8% females).3 More recent data from 2014 shows that overall, percentages of suicides in the United States involving suffocation (including hanging and strangulation) increased from 1999–2014, while suicides by firearm and poisoning decreased.2

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Nonfatal suicide attempts are more prevalent than suicides, with ranges between 5% and 8% of youths annually.4 It is estimated that there is one completed suicide per 100 to 200 suicide attempts among youth between 15 and 24 years old, which is a greater ratio than for adults.5 Results from the 2015 national Youth Risk Behavior Surveillance (YRBS) indicated that 17.7% of high school students nationwide had seriously considered attempting suicide in the past year, 14.6% had made a plan about how they would attempt suicide and 8.6% had attempted suicide one or more times during the 12 months before the survey.6 Suicidal ideation and attempts were higher among females than males and greater in Hispanic females than black or white females.6

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With numbers and prevalence this high it is important that pediatricians are not only aware of the issue of suicide, but feel competent in helping address this problem. This includes screening for suicidality in youth (many youth may not open up about suicidal ideation unless directly asked), conducting an adequate suicide assessment, and knowing how to acutely manage patients who are suicidal or have had a suicide attempt.7-9

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PATHOPHYSIOLOGY

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Understanding Suicidality: Biological, Psychological, and Social Etiological Factors
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An increase in both suicide and suicide attempts is seen with adolescence.3,7,10 This increase is likely attributed to biological, psychological, and social factors that influence each other. Adolescent brains are still developing, including the frontal lobes ...

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