In the TADS study, predictors of suicidal events included higher levels of self-reported suicidal ideation and depression at baseline, persistent depression, minimal improvement in depression, and acute interpersonal conflict (eg, conflict with parents or peers).3 In the TORDIA study, predictors of suicidal events were high baseline suicidal ideation, family conflict, and drug or alcohol(Drug information on alcohol) use.4 In the ADAPT trial, nonsuicidal self-injury, high suicidality, and family dysfunction were factors predictive of future suicide attempts. A history of nonsuicidal self-injury was a stronger predictor of suicide attempts than a prior history of a suicide attempt.5
Séguin and colleagues6 examined the effects of adversity on youths and young adults who committed suicide. The sample group included 67 persons who committed suicide; 36% were younger than 19 years. The control group consisted of 56 living individuals matched for age and sex.
Serious adversity was found to occur at a young age in the suicidal group compared with the nonsuicidal group. Half of the children in the suicidal group were exposed to abuse, physical violence, and/or sexual violence between birth and age 4 years. In the 5- to 9-year-old group, 60% were exposed to abuse or violence. By age 10 to 14 years, 77% of the group were exposed to these adversities. In contrast, the rates of abuse and violence in the nonsuicidal group were 14%, 18%, and 34%, respectively. The researchers note that the cumulative burden of adversity is greater for individuals with an earlier exposure to abuse and violence.
In a compelling editorial, Brent7 comments that identification of risk factors has been insufficient in preventing youth suicides. He argues that protective factors should be a research focus and that interventions should be directed toward family and personal resiliency. He suggests that consideration be given to an intervention that both treats the current disorder and fosters long-term resilience. He also recommends that health risk behaviors, such as substance use and risky sexual behavior, be included in interventions with suicidal youth.