Youth Suicide: The First Suicide Attempt.

A mainstay in the identification and management of youth at risk for suicide is the use of suicide risk factors, such as past suicide attempt(s), past or current suicidal ideation, mood disorders, substance use disorders, psychosis, male gender, and lack of family support.1 A history of at least 1 medically serious suicide attempt2 or violent self-harm3 is a particularly important risk factor. This phenomenon has been studied mostly with clinical samples, such as cohorts of patients initially admitted to a hospital for an attempt, having used a particular self-harm method, or seen in an emergency department.4 Olfson et al.3 used Medicaid claims data and tracked patients for 1 year after an episode of self-harm. However, these studies could not contextualize completed suicides that were not preceded by an attempt or other self-harm. McKean et al.,5 in this issue of JAACAP, used a community sample to identify a cohort followed from the first suicide attempt that came to medical attention to the index attempt (IA), including an IA resulting in death. This approach facilitated an analysis that included individuals who lived after or died from the IA, receipt of care, subsequent suicide completion, method of IA and completed suicides, and individuals' demographic and clinical characteristics.