Center for Injury Research and Prevention

Suicide and Self-Harm

Youth suicide prevention
If you, or someone you know, are in crisis, call the National Suicide Prevention Lifeline.

It can be hard to understand what would drive someone to take his or her own life. Suicide is a desperate attempt to escape suffering. Many people with suicidal thoughts do not want to die – they want to end their pain. Suicidal people can be blinded by their despair and see no other option.

This is a serious, but preventable, mental health issue that affects people of any age, gender, sexuality, race, and socioeconomic status. Approximately 45,000 Americans die each year from suicide, which is more than twice the number of homicides. It has become an increasing public health problem among youth and young adults. In 2016, suicide was the second leading cause of death among 10– 24-year-olds (after unintentional injury) and in 2014 death by suicide became more common than death by traffic crashes among children 10-14 years old.

Suicidal thoughts result from extreme emotional distress and are not necessarily signs of mental illness. This is a common misconception. Abuse, bullying, family stress, and sexual orientation are all risk factors for youth suicide.

Severe distress and emotional pain can also manifest in other unhealthy ways. Self-harm, intentionally inflicting pain on one’s self, is a negative coping mechanism and emotional outlet. Each year, approximately 1 in 5 females and 1 in 7 males hurt themselves on purpose. There is a multitude of reasons why adolescents self-harm, including desperation, anger, anxiety, a cry for help, and the desire to “feel something” in those who may feel otherwise “numb” to emotions. While these individuals are at a higher risk of suicide, self-injury is often unrelated to suicidal ideation. One of the most common forms of self-injury is cutting, the act of making small cuts on one’s body. Like other forms of self-harm, some youth report that this provides a sense of relief from overwhelming negative feelings.  Self-harm should be taken seriously. 

Facts & Statistics About Youth Suicide

  • From 2007 to 2017, the youth suicide rate increased by 58 percent, according to a NCHS Data Brief.
  • In 2016, more than 6,000 young people under age 25 committed suicide, according to the CDC’s Fatal Injury Reports. 2,500 youth were 19 years or younger.
  • Suicide attempts among black and Hispanic youth are almost 2 times higher than white youth.
  • LGB youth are almost 5 times more likely to attempt suicide as their straight peers.
  • In 2017, according to the National Youth Risk Behavior Survey 17 percent of high-school students self-reported seriously considering suicide, while 14 percent made a suicide plan and 7.4 percent attempted suicide,
  • Studies show that 45 percent of suicide victims had contact with primary care providers within 1 month of suicide.
  • Having a gun in the home, regardless of storage practice, type of gun, or number of firearms, is associated with an increased risk of firearm suicide.
  • States implementing universal background checks and mandatory waiting periods prior to the purchase of a firearm show lower rates of suicides than states without this legislation. To read more about suicide and firearms, click here.
  • A 2017 study of ER and inpatient encounters across 32 US children's hospitals revealed the annual percentage of encounters identified as suicidality or self-harm for children ages 5-17 more than doubled over the 8-year study period. Read more about addressing suicide risk in young children.

Youth Suicide Prevention: Know the Warning Signs

The best way to prevent youth suicide is to recognize the warning signs, including but not limited to:

  • Talking about suicide, dying, or self-harm
  • Looking for access to guns, pills, or other lethal means
  • Unusual preoccupation with death, dying, or violence
  • Talking about feeling hopeless or having no reason to live
  • Talking about feeling trapped or in unbearable pain
  • Talking about being a burden to others
  • Expressing feelings of self-loathing, worthlessness, guilt, and shame
  • Increasing the use of alcohol or drugs and other self-destructive behaviors
  • Sleeping too little or too much
  • Withdrawing from friends and family
  • Showing rage or talking about seeking revenge
  • Loss of touch with reality, seeing things or hearing voices
  • Displaying extreme mood swings.

Clinical Screening Can Help Prevent Youth Suicide

These signs can be easy to miss. An estimated 70 percent of children suffer with untreated mental health problems. Routine behavioral health (BH) screening in acute-care settings like the emergency department, as well as primary care and sub-specialty outpatient visits would help reduce the number of adolescents with unmet mental health needs.

Researchers at Children’s Hospital of Philadelphia (CHOP) developed the Behavioral Health Screen (BHS), a comprehensive, web-based tool, to assess and identify BH symptoms among adolescents such as depression, anxiety, and suicidal risk. The screening also identifies potential urgent risks, such as suicide attempts and sexual abuse. A study found that the application of BHS in the Emergency Department increased the identification of mental health problems by 8 percent. When tested in primary care settings, they found that 9.2 percent of adolescent patients admitted to having suicidal thoughts.

Even though screening tools, such as the BHS, have proven to be an important first step to address our country’s growing mental health problem, the barriers to implementation (e.g., lack of time, training, and capacity) hinder integration into the primary and emergency care settings. Overcoming these barriers is the goal of several researchers at CHOP who aim to fully integrate BH screening into medical settings and establish its importance as a clinical practice. CHOP is also a site for a National Institute of Mental Health study to develop and validate a suicide-specific screening tool.

Once suicidal or at-risk youth (e.g. significant depression) are identified, timely evaluation is needed in order to intervene and determine the appropriate plan. Healthcare organizations and communities must work together to tackle this public health crisis despite barriers. At CHOP, multidisciplinary teams strive to develop innovative care models and advocate for better resources and legislation.

Youth Suicide Prevention: Increase Awareness

In 2017, the National Action Alliance for Suicide Prevention released an update to the National Strategy for Suicide Prevention. The report focuses on four strategies to reducing the number of deaths by suicide

  1. Create healthy and empowered individuals, families, and communities
  2. Develop, implement, and monitor clinical and community preventive services
  3. Provide appropriate treatment and support services
  4. Improve the quality of data on suicidal behaviors to develop increasingly effective prevention efforts

If you, or someone you know, are in crisis, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255)

Crisis Text Line: Text “Home” to 741741 for free, 24-hour support

Read Research in Action blog articles about suicide prevention.

Recommended Reading & Resources

The American Foundation for Suicide Prevention

National Institute of Mental Health: Suicide Prevention

Centers for Disease Control and Prevention

National Action Alliance for Suicide Prevention

Yellow Ribbon Suicide Prevention Program

Feeling Blue Suicide Prevention Program

The Trevor Project

Suicide and Depression Awareness for Students

Suicide Prevention in College

Research Articles

Doupnik SK, Esposito J, Lavelle J. Beyond Mental Health Crisis Stabilization in Emergency Departments and Acute Care Hospitals. Pediatrics. 2018;141(5): e20173059

Bevans, KB, Diamond G, Levy S. Screening for Adolescents' Internalizing Symptoms in Primary Care: Item Response Theory Analysis of the Behavior Health Screen Depression, Anxiety, and Suicidal Risk Scales. Journal of Developmental and Behavioral Pediatrics, 33(4), May 2012.

Diamond G, Levy S, Bevans KB,  Fein JA, Wintersteen M, Tien A, Creed T. Development, Validation and Utility of Internet-based, Behavioral Health Screen for AdolescentsPediatrics. 2010;126(1):e163-70.

Fein JA, Pailler M, Diamond G, Wintersteen M, Tien A, Hayes K, Barg F. Feasibility and Effects of a Web-based Adolescent Psychiatric Assessment Administered by Clinical Staff in the Pediatric Emergency DepartmentArchives of Pediatric and Adolescent Medicine 2010;164(12):1112-1117.

Pailler ME, Fein JA. Computerized Behavioral Health Screening in the Emergency DepartmentPediatric Annals, 38(3), March 2009.