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Paediatric suicide in the USA: analysis of the National Child Death Case Reporting System
  1. Theodore E Trigylidas1,
  2. Eliza M Reynolds1,
  3. Getachew Teshome1,
  4. Heather K Dykstra2,
  5. Richard Lichenstein1
  1. 1Division of Emergency Medicine, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
  2. 2National Center on Fatality Review, Okemos, Michigan, USA
  1. Correspondence to Dr Richard Lichenstein, Division of Emergency Medicine, Department of Pediatrics, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA; rlichenstein{at}


Importance Suicide is a leading cause of death among youths. The relationship between mental health, psychosocial factors and youth suicidality needs further analysis.

Objective To describe paediatric suicide in the USA and the impact of mental health and substance abuse using the National Child Death Review Case Reporting System (CDR-CRS). To identify psychosocial correlates contributing to suicide and whether these factors are more common among individuals with history of mental illness or substance abuse.

Design Deidentified data (CDR-CRS) from 2004 to 2012 was obtained from 29 participating states. Demographic data and psychosocial correlates, including age, gender, cause of death, history of mental illness and/or substance abuse, school concerns, previous suicide attempts and family history of suicide, were collected.

Results A total of 2850 suicides were identified. Mean age was 15.6±1.9 years; (range 7–21 years) 73.6% male and 65.1% Caucasian. The leading causes of death were asphyxia (50.2%) and weapon/firearm (36.5%). Among all subjects, 25.5% had history of mental illness and 19.0% had history of substance abuse. 60.0% had no report of mental illness or substance abuse. Subjects with both mental illness and substance abuse were more likely to have school concerns (OR=4.1 (p<0.001)), previous suicide attempts (OR=4.2 (p<0.001)) and a family history of suicide (OR=3.2 (p<0.001)) compared with subjects without those characteristics.

Conclusions Most suicide records in the CDR-CRS had no indication of mental illness or substance abuse. The youth with mental-illness/substance-abuse issues were more likely to have other compounding psychosocial correlates that may be warning signs of suicide.

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