Suicide and Self-Harm

If you, or someone you know, are in crisis, dial 988 to call the 988 Suicide & Crisis Lifeline.

It can be hard to understand what would drive someone to take their 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.

Suicide is a serious and complex, but preventable, mental health issue that affects people of any age, gender, sexuality, race, and socioeconomic status. Approximately 49,000 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 2023, suicide was the second leading cause of death among 10– 24-year-olds (after unintentional injury) and for 15-24 year-olds, death by suicide is more common than the 4th through 15th causes of death combined, including cancer, heart conditions, and infections. 

Suicidal thoughts result from extreme emotional distress and are not necessarily signs of mental illness. This is a common misconception. Abuse, bullying, substance abuse, psychiatric disorders and/or medical conditions, family stress, aggressive and/or impulsive behavior, family history, 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 an unhealthy coping mechanism and emotional outlet. There are a multitude of reasons why children and adolescents engage in self-harm, including desperation, coping with emotional distress, anger, anxiety, a cry for help, and the desire to “feel something” in those who may feel otherwise “numb” to emotions. Although these individuals are at a higher risk of suicide, self-injury is often not accompanied by 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. 

Suicide and Self-Harm Facts and Stats

Facts & Statistics About Youth Suicide
  • Suicide rates for youth and young adults ages 10-25 years increased 52% between 2000 and 2021 according to the CDC.
  • In 2023, approximately 6,500 young people under age 25 died by suicide, according to the CDC.
  • LGBTQ+ youth are almost 5 times more likely to attempt suicide as their straight peers.
  • In 2023, according to the national Youth Risk Behavior Survey 20% of all high school students seriously considered attempting suicide, while 16% made a suicide plan and 9% attempted suicide one or more times.
  • Studies show that 45% of suicide victims had contact with primary care providers within 1 month of suicide and 60% of youth who die by suicide do not have documented history of a mental health disorder.
  • Having a gun in the home, regardless of storage practice, type of gun, or number of firearms, is associated with an increased risk of suicide death by firearm.
  • 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.
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
  • Acting anxious or agitated; reckless behavior
  • 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

These signs can be easy to miss. An estimated 70% 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%. When tested in primary care settings, they found that 9.2% 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.

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: National Organizations

National organizations, such as the American Academy of Pediatrics (AAP) and the Zero Suicide Institute, have increased their focus on youth suicide prevention. The AAP Blueprint for Youth Suicide Prevention was developed in response to the national emergency about youth suicide declared by the AAP, the American Academy of Child and Adolescent Psychiatry (AACAP), and the Children’s Hospital Association (CHA). The Zero Suicide Institute developed the Zero Suicide Toolkit for Children's Hospitals as an adaptation of the Zero Suicide framework to meet the needs of children and adolescents in health care settings. The Zero Suicide framework for suicide prevention includes 7 elements to guide health care organizations with comprehensive approach to reducing youth suicide: Lead, Train, Identify, Engage, Treat, Transition and Improve.  

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