Risk Factors for Suicidal Behavior in Children and Adolescents

Risk Factors for Suicidal Behavior in Children and Adolescents
Type	Examples
Psychiatric disorders and general medical disorders that affect the brain	Mood disorders* (eg, schizophrenia, depressive disorders) Substance use, particularly alcohol and THC† and/or substance use in adolescents Aggressive, impulsive tendencies (conduct disorder) Previous suicide attempts Traumatic head injury (TBI) Posttraumatic stress disorder (PTSD) Anxiety disorders
Family history	Family history of suicidal behavior Completed suicide in adults Parental opioid use‡ Mother with a mood disorder Father with a history of trouble with law enforcement Poor communication with parents
Psychosocial factors	Recent disciplinary action§ (most commonly, school suspension) Interpersonal loss (loss of a girlfriend or boyfriend, especially in boys; separation from parents) Difficulties in school Social isolation (particularly not working or going to college) Victim of bullying Media reports of suicide (copycat suicide) Identification as LGBTQ+ (lesbian, gay, bisexual, transgender, queer/questioning)
Environmental factors	Easy access to lethal methods (eg, guns) Barriers to and/or stigma associated with accessing mental health services
Medications	MontelukastMontelukast^a GabapentinGabapentin^b Selective serotonin reuptake inhibitors^{c, d} PrednisonePrednisone^d Benzodiazepines^d(alprazolam, diazepam)(alprazolam, diazepam)
* Mood disorders are present in more than one-half of suicidal adolescents.
† Gobbi G, Atkin T, Zytynski, et al. Association of cannabis use in adolescence and risk of depression, anxiety, and suicidality in young adulthood: A systematic review and meta-analysis. JAMA Psychiatry. 76(4):426-434, 2019. doi: 10.1001/jamapsychiatry.2018.4500
‡ Turecki G, Brent DA, Gunnell D, et al. Suicide and suicide risk. Nat Rev Dis Primers. 5(1):74, 2019. doi: 10.1038/s41572-019-0121-0
§ Almost half of completed suicides occur after recent disciplinary action. ^aBenard B, Bastein V, Vinet B, et al. Neurosychiatric adverse drug reactions in children initiated on montelukast in real-life practice. . Neurosychiatric adverse drug reactions in children initiated on montelukast in real-life practice.Eur Respir J. 50(2):1700148. doi: 10.1183/13993003.00148-2017 ^bMolero Y, Larsson H, D'Onofrio B, et al. Associations between gabapentinoids and suicidal behaviour, unintentional overdoses, injuries, road traffic incidents, and violent crime: Population based cohort study in Sweden. BMJ Clin Res. 365:12147, 2019. doi: 10.1136/bmj.l2147 ^cGibbons RD, Brown CH, Hur K, et al. Early evidence on the effects of regulators' suicidality warnings on SSRI prescriptions and suicide in children and adolescents. Am J Psychiatry. 164(9);1356-1363, 2007. doi: 10.1176/appi.ajp.2007.07030454 ^dGibbons R, Hur K, Lavigne J, et al. Medications and suicide: High dimensional empirical Bayes screening (iDeas). Harvard Data Sci Rev. 1.2 2019 (revised 2020). doi: 10.1162/99608f92.6fdaa9d

* Mood disorders are present in more than one-half of suicidal adolescents.

† Gobbi G, Atkin T, Zytynski, et al. Association of cannabis use in adolescence and risk of depression, anxiety, and suicidality in young adulthood: A systematic review and meta-analysis. JAMA Psychiatry. 76(4):426-434, 2019. doi: 10.1001/jamapsychiatry.2018.4500

‡ Turecki G, Brent DA, Gunnell D, et al. Suicide and suicide risk. Nat Rev Dis Primers. 5(1):74, 2019. doi: 10.1038/s41572-019-0121-0

§ Almost half of completed suicides occur after recent disciplinary action.

^aBenard B, Bastein V, Vinet B, et al. Neurosychiatric adverse drug reactions in children initiated on montelukast in real-life practice. . Neurosychiatric adverse drug reactions in children initiated on montelukast in real-life practice.Eur Respir J. 50(2):1700148. doi: 10.1183/13993003.00148-2017

^bMolero Y, Larsson H, D'Onofrio B, et al. Associations between gabapentinoids and suicidal behaviour, unintentional overdoses, injuries, road traffic incidents, and violent crime: Population based cohort study in Sweden. BMJ Clin Res. 365:12147, 2019. doi: 10.1136/bmj.l2147

^cGibbons RD, Brown CH, Hur K, et al. Early evidence on the effects of regulators' suicidality warnings on SSRI prescriptions and suicide in children and adolescents. Am J Psychiatry. 164(9);1356-1363, 2007. doi: 10.1176/appi.ajp.2007.07030454

^dGibbons R, Hur K, Lavigne J, et al. Medications and suicide: High dimensional empirical Bayes screening (iDeas). Harvard Data Sci Rev. 1.2 2019 (revised 2020). doi: 10.1162/99608f92.6fdaa9d

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Suicidal Behavior in Children and Adolescents