Suicide in adolescents.

In many parts of the world rates of suicidal behaviour are increasing among young people. Community surveys of suicidal ideation have demonstrated that up to 24% of adolescents have experienced suicidal thoughts at some point in their lives. Rates of attempted suicide are highest among young people, and increased occurrence is reported, particularly among young males. A similar picture emerges with regard to completed suicide, and in some countries rates of suicide among young males are higher than those for older age groups. Risk factors can be grouped according to their social/familial, individual, or environmental nature. Based on these findings an explanatory model of suicidal behaviour can be developed, in which three criteria can be discerned: i.e. trait-dependent factors, including those related to serotonin, personality and cognitive psychological dysfunctions; state-dependent characteristics, such as depression and hopelessness; and threshold factors, which may have a risk-enhancing or protective effect, such as social support, contagion effects, the availability of means, and the accessibility of mental health care. Preventive actions need to be developed, targeting the general population (through, for example, educational programmes) or populations at particular risk, such as adolescents attempting suicide. Potential treatment approaches include the treatment of individual psychopathological phenomena, whether or not in school-based clinics, but particular attention has to be given to inducting and keeping young people at risk in treatment.