Suicidal Behavior In Children Research Articles

RE: Suicidal Behaviours among Polish Youth in Light of the following Papers: Suicidal Behaviour in Children and Adolescents. Parts 1 and 2

RE: Suicidal Behaviours among Polish Youth in Light of the following Papers: Suicidal Behaviour in Children and Adolescents. Parts 1 and 2

Psychological Maltreatment and Adolescents’ Suicidal Behavior: A Nationwide Sample of 1,055 Children at Risk

The purpose of this article is to shed light on the questions: Do children who are exposed to psychological maltreatment have an increased risk for suicide attempts or contemplation? Will children's suicidal behavior diminish when psychological maltreatment is reduced? Suicidal behavior as well as child abuse and neglect were analyzed on the basis of standardized questionnaires addressed to caseworkers assigned to these cases (N = 1,055). Half of the children were exposed to abuse and neglect. More than one third of the children were exposed to psychological maltreatment. Children exposed to psychological maltreatment showed higher rates of suicidal tendencies compared to those children who were not exposed to psychological maltreatment.

No Difference in Suicidal Acts Found for Antidepressant Types

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessNo Difference in Suicidal Acts Found for Antidepressant TypesJun YanJun YanSearch for more papers by this authorPublished Online:21 May 2010https://doi.org/10.1176/pn.45.10.psychnews_45_10_029AbstractThe rate of attempted and completed suicide did not differ between pediatric patients who were started on selective serotonin-reuptake inhibitors (SSRIs) and those taking tricyclic antidepressants, a large observational study has shown.All antidepressants are required by the Food and Drug Administration (FDA) to carry a boxed warning in their labels regarding an increased risk of suicidality, including suicidal thoughts and behaviors, for children and young adults up to age 24. This risk was initially reported in patients using paroxetine, but the FDA decided in 2004 to mandate the warning on suicidality for all antidepressants, including tricyclics.The study, published online in Pediatrics on April 12, indicates that the total rate of suicidal acts, including attempted and completed suicides, within one year of antidepressant initiation was not significantly different between 10- to 18-year-old patients who started on SSRIs and those who started on tricyclics.Because attempted and completed suicides are rare events, a large population base is needed to conduct a meaningful risk analysis. The authors, led by Sebastian Schneeweiss, M.D., Sc.D., an associate professor of medicine at Harvard Medical School and vice chief of the Division of Pharmacoepidemiology and Pharmacoeconomics at the Brigham and Women's Hospital, examined provincial health care data on nearly 21,000 pediatric patients in British Columbia within a nine-year period between January 1, 1997, and December 31, 2005. All patients included in the analysis were diagnosed with depression and were taking an antidepressant at the time due to a suicide-related hospitalization.Within the first year of using an antidepressant, 266 youths made attempts, and three died of suicide. The incidence was calculated at approximately 27 suicidal acts per 1,000 person-years. Suicide attempts and suicides were identified by ICD-9 and ICD-10 diagnostic codes.The authors found no statistically significant difference in the risk of suicidal acts between patients who started on SSRIs and those who started on tricyclics. Nor were there significant differences in the risk of suicidal acts within the SSRI drug class in the comparisons among citalopram, fluvoxamine, paroxetine, sertraline, and fluoxetine.The authors also found that most of the suicidal acts took place within the first six months after antidepressant initiation.“The interpretation of these findings is limited by a number of methodological factors,” David Fassler, M.D., commented to Psychiatric News. For example, the authors evaluated only pediatric patients who were hospitalized as a result of attempted suicide or completed suicide, but “research has demonstrated that the majority of children and adolescents with suicidal ideation, self-harm, and even suicide attempts are never hospitalized,” he noted.Fassler is a child and adolescent psychiatrist and a clinical professor of psychiatry at the University of Vermont College of Medicine. He is also the APA secretary/treasurer.Fassler pointed out several other limitations of this study. The authors included patients with a diagnosis of depression but not anxiety disorders, although anxiety symptoms may have an impact on suicidal behaviors different from that of depression. Also, they did not take into consideration the changes in prescribing patterns before and after the regulatory warnings between 2003 and 2005, which have been highlighted in other studies. These factors “could easily have influenced the results in a variety of ways,” said Fassler.Despite the FDA warnings, the extent to which antidepressants may induce suicidal thoughts and behaviors is still not well established, especially among adolescents who are at high risk for suicidal behaviors without treatment because of an underlying mental illness. After the regulatory warnings were issued, epidemiologists saw a spike in youth suicide that may or may not be associated with decreased use of these medications (Psychiatric News, October 5, 2007; October 3, 2008).This current study does not answer the question of whether or how much antidepressants increase suicidal behaviors in children and adolescents, as the authors did not compare the incidence of suicide attempts and suicides in young people who were not treated with antidepressants with that of those who were treated with antidepressants, Fassler suggested. He hopes that future large-scale, longitudinal studies will fully address these issues, including the public-health consequences of the boxed warning.The study was funded by the National Institute of Mental Health.An abstract of “Comparative Safety of Antidepressant Agents for Children and Adolescents Regarding Suicidal Acts” is posted at <pediatrics.aappublications.org/cgi/content/abstract/peds.2009-2317v1>. ISSUES NewArchived

Suicidal behavior in children and adolescents

In this remarkably clear and readable evaluation of the research on this topic, Barry Wagner presents the current state of knowledge about suicidal behaviors in children and adolescents, addressing the trends of the past ten years and evaluating available treatment approaches. Wagner provides an in-depth examination of the problem of suicidal behavior within the context of child and adolescent behavior. Among the developmental issues covered are the evolving capacity for emotional self-regulation, change and stresses in family, peer, and romantic relationships, and developing conceptions of time and death. He also provides an up-to-date review of the controversy surrounding the possible influence of antidepressant medications on suicidal behavior. Within the context of an integrative model of the suicide crisis, Wagner discusses issues pertaining to assessment, treatment, and prevention.

Child Suicide, Family Environment, and Economic Crisis

Suicide among children is considered to be a rare event, although it is still one of the leading causes of death in children younger than 15 years of age worldwide (Pelkonen & Marttunen, 2003; Vajani, Annest, Crosby, Alexander, & Mille, 2007). Compared to other age groups, the prevalence of suicide in children is more likely to be underestimated (Beautrais, 2001; Crepeau-Hobson, 2010; Fortune & Hawton, 2007; McClure, 2001). Possible reasons for this underestimation may be the social stigma and shame surrounding suicide in general, the reluctance by officials or coroners to determine a verdict of suicide in a child, disparities in death classification systems, and/or the misconception that children are precluded from engaging in suicidal acts due to cognitive immaturity (Crepeau-Hobson, 2010; Schmidt, Muller, Dettmeyer, & Madea, 2002; Shaw, Fernandes, & Rao, 2005; Pritchard & Hansen, 2005). However, research has indicated that, from the age of 8 on, children understand the concept of suicide (Mishara, 1998; Fortune & Hawton, 2007) and are capable of carrying it out. Research in adolescent and youth suicide is growing. While previous studies provided a broad overview of the phenomenon, few focused specifically on suicide in children. There appears to be some empirical support for the notion that children may be less exposed to common suicide risk factors, such as mental illness and substance abuse, and less likely to display predictive factors, such as prior suicidal behavior (Beautrais, 2001; Groholt, Ekeberg, Wichstrom, & Haldorsen, 1998; Pelkonen & Marttunen, 2003; Schmidt et al., 2002). Groholt et al. (1998) suggested that the low suicide incidence in children might be related to fewer risk factors rather than to their resilience to these risk factors. Interpersonal family conflicts, especially parent-child conflicts, are important suicide risk factors in children and younger adults and appear more frequently compared to older adults. Beautrais (2001) reported that 70.5% of child suicides aged 9–14 years had a family conflict as a triggering factor. Furthermore, it has been reported that parental divorce or a stepparent in the family increases the risk of suicidal behaviors in children and adolescents (Pelkonen & Marttunen, 2003; Samm et al., 2010). A growing body of research indicates that the risk of child and adolescent suicide and attempted suicides increases when family psychopathology is involved, such as parental mental health problems or a history of suicidal behavior (King, 2009). However, the existence and impact of shared genetic risk factors, the level of influence of an adverse family environment, and whether these influences can be mediated remain unknown in the context of child suicide (Brent & Mann, 2006; King, 2009). It also appears that the family environment – parenting style, physical abuse, and parental mental health problems – can be greatly influenced by economic pressure (Yoder & Hoyt, 2005). Since the beginning of the global financial crisis, several editorials and papers have indicated the possible impact the economic recession may have on morbidity (Catalano, 2009; Uutela, 2010), mortality (Simms, 2009), and, more specifically, suicide (Gunnell, Platt, & Hawton, 2009). Indeed, based on past experiences and from a public health perspective, it is very important to notify professionals and politicians about the possible consequences (Stuckler, Basu, Suhrcke, Coutts, &McKee, 2009). Meanwhile, speculations continue about eventual scenarios, as it is too early to see the impact the global financial crisis might have on overall suicide mortality and morbidity rates. The effects of an economic recession on children, general child mortality and morbidity, violence against children, schooling, quality of care, and emotional well-being also need to be considered (Harper, Jones, McKay, & Espey, 2009). Yet, how much do we know about the possible fallouts of an economic crisis on children, their suicidal behaviors, and child suicides? The impact of an economic recession can be measured both on an aggregated and an individual level. In a recent paper, Apter, Bursztein, Bertolote, Fleischmann, and Wassermann (2009) considered that turmoil following rapid changes in the economy has been

Depression and the conduct disorder are the most frequent pathologies in child and adolescent suicide attempt

Until recently, suicidal behaviour in children and adolescents was associated to less serious psychopathological disorders, such as adjustment disorder. In the last decades, according to international sources, psychopathological disorders associated to suicide attempts have become more serious. To describe the frequency of mental and conduct disorders in children and adolescents that attempted suicide, in order to identify self-aggression methods and previous psychopathological antecedents. Cross sectional study based on clinical interviews to 41 children and adolescents hospitalized in Hospital de Niños de Córdoba for suicide attempt. Ingestion of psychotropics is the most frequent self-aggression method (p< 0.0001). Psychopathological history, such as previous suicide attempt and conduct disorder, were predominant (p< 0.0001) in children and adolescents hospitalized for suicide attempt. Pathologies most frequently associated to suicide attempt were depression (29.27%) and conduct disorder (24.39%). Children and adolescents with suicide attempt had previous psychopathological antecedents and important mental disorders such as depression and conduct disorder, which require adequate treatment and sanitary control, in order to avoid more severe consequences. The most used method to attempt suicide was ingestion of psychotropics.

Depression and Suicidal Behaviour in Children and Adolescents

This article provides an overview of the diagnosis and management of depression, focusing on the primary care setting. We also discuss suicidal behaviour, which may be a symptom of depressive disorder but can also be indicative of other difficulties. Therapeutic interventions for suicidal behaviour are described.

Depression, suicidality and antidepressants: A coincidence?

Byline: Vithyalakshmi. Selvaraj, Snehamala. Veeravalli, Sriram. Ramaswamy, Richard. Balon, Vikram. Yeragani Major depressive disorder is currently one of the leading causes of disability world-wide and projected by the World Health Organization (WHO) to become the second leading cause of disability after heart disease by the year 2020. Suicidal ideation and behavior are the most serious and common psychiatric emergencies among the depressed population. In 2004, suicide was the eleventh leading cause of death in the U.S.[sup] [1] The overall rate was 10.9 suicide deaths per 100,000 people. An estimated 8 to 25 attempted suicides occur per every suicide death. It is reassuring that depressed patients usually respond to treatment with antidepressants. In fact, population-based studies examining rates of antidepressant use and suicide over time, have generally found lower rates of suicide with increasing rates of antidepressant use.[sup] [2],[3],[4],[5],[6],[7],[8] However, in 2003, publication of data linking antidepressant use to suicide and suicidal behavior in children and teenagers sparked off worldwide public health concern. This prompted the US Food and Drug Administration (FDA) to mandate manufacturers of all antidepressants (including tricyclic antidepressants [TCAs] and monoamine oxidase inhibitors) to include a warning stating that antidepressants may increase the risk of suicidal ideation and behavior in children, adolescents and young adults less than 25 years old. The 'black box' warning, although meant to safeguard public health has had serious spillover effects on pharmacotherapy of depression. There have been recent reports of a rise in suicide rates among the youth and a decline in depression care among the older adults. We critically evaluate this association in order to provide more clarity while assessing the benefits of antidepressant use versus any risk of self-harm associated with them. Impact of Depression Depression is a pathological and pervasive state of mood. The lifetime risk of developing major depressive disorder is 16.2% in the United States. Recurrence is the rule, and about one-third of patients go on to develop chronic depression. Depression increases mortality because it worsens many medical conditions such as cardiovascular disease and diabetes and increases the risk of suicide. Depressed patients are high utilizers of healthcare services and typically perform poorly in the workplace. The mean age of onset, from a number of studies, is in the late 20s. Although twice as many females as males report or receive treatment for clinical depression, this gap has significantly narrowed in the recent past. Also, this difference disappears after the age of 50-55, when most females are post-menopausal. Suicidal ideation and attempts are common in depressed patients. Each year, about 30,000 people in the United States and one million worldwide die by suicide. Approximately 650,000 people in the United States receive emergency treatment each year after attempting suicide. Antidepressants Benefits and Risks Mono amine oxidase inhibitors (MAOI) and tricyclic antidepressants (TCA) were the mainstays of treatment for depression until the introduction of Serotonin Reuptake Inhibitors (SSRIs) in the late 1980's. Currently, SSRIs are the most commonly prescribed antidepressants. The therapeutic effects of antidepressants are believed to be related to their ability to facilitate serotonin, norepinephrine and/or dopamine neurotransmission. Despite the early increase in concentration of monoamine neurotransmitters at receptor sites, clinical antidepressant benefits are not evident until several weeks. One explanation for this therapeutic lag is the theory that down-regulation of neurotransmitter receptors is a consequence of excess signaling, a process that takes several weeks and ultimately responsible for the alleviation of depressive symptoms. Overall, antidepressants are very effective in treating depression and its associated complications. …

Understanding and Treating Unwanted Trauma Memories in Posttraumatic Stress Disorder

Distressing and intrusive reexperiencing of the trauma is a hallmark symptom of posttraumatic stress disorder (PTSD; American Psychiatric Association, 1994). However, unwanted memories of trauma are not a sign of pathology per se. In the initial weeks after a traumatic experience, intrusive memories are common. For most trauma survivors, intrusions become less frequent and distressing over time. A central question for understanding and treating patients with PTSD is therefore what maintains distressing intrusive reexperiencing in these people. Three factors appear to be important: (1) memory processes responsible for the easy triggering of intrusive memories, (2) the individuals’ interpretations of their trauma memories, and (3) their cognitive and behavioral responses to trauma memories.

The Moderating Effects of Parenting Styles on African-American and Caucasian Children’s Suicidal Behaviors

Given that parenting practices have been linked to suicidal behavior in adolescence, examining the moderating effect of parenting styles on suicidal behavior early in development could offer potential insight into possible buffers as well as directions for suicide prevention and intervention later in adolescence. Hence, the moderating effects of parenting styles, including authoritarian, permissive, and features of authoritative parenting, on depressed and aggressive children's suicidal behavior, including ideation and attempts, were evaluated with young children (N = 172; 72% male, 28% female) ranging from 6 to 12 years of age. African American (69%) and Caucasian (31%) children admitted for acute psychiatric inpatient care completed standardized measures of suicidal behavior, depressive symptoms, and proactive and reaction aggression. Their parents also completed standardized measures of parental distress and parenting style. Hierarchical regression analyses revealed that, while statistically controlling for age and gender, children who endorsed more depressive symptoms or reactive aggression reported more current and past suicidal behavior than children who endorsed fewer depressive or aggressive symptoms. The significant positive relationship observed between depressive symptoms and childhood suicidal behavior, however, was attenuated by parental use of authoritarian parenting practices for African-American and older children but not for younger and Caucasian children. The ethnic/racial difference observed for the buffering effect of authoritarian parenting practices offers potential theoretical and clinical implications for conceptualizing the moderating effects of parenting styles on African-American and Caucasian children's suicidal behavior.

Child Behavior Checklist Juvenile Bipolar Disorder (CBCL‐JBD) and CBCL Posttraumatic Stress Problems (CBCL‐PTSP) scales are measures of a single dysregulatory syndrome

The Child Behavior Checklist Juvenile Bipolar Disorder (CBCL-JBD) profile and Posttraumatic Stress Problems (CBCL-PTSP) scale have been used to assess juvenile bipolar disorder (JBD) and posttraumatic stress disorder (PTSD), respectively. However, their validity is questionable according to previous research. Both measures are associated with severe psychopathology often encompassing multiple DSM-IV diagnoses. Further, children who score highly on one of these scales often have elevated scores on the other, independent of PTSD or JBD diagnoses. We hypothesized that the two scales may be indicators of a single syndrome related to dysregulated mood, attention, and behavior. We aimed to describe and identify the overlap between the CBCL-JBD profile and CBCL-PTSP scales. Two thousand and twenty-nine (2029) children from a nationally representative sample (1073 boys, 956 girls; mean age = 11.98; age range = 6-18) were rated on emotional and behavior problems by their parents using the CBCL. Comparative model testing via structural equation modeling was conducted to determine whether the CBCL-JBD profile and CBCL-PTSP scale are best described as measuring separate versus unitary constructs. Associations with suicidality and competency scores were also examined. The CBCL-JBD and CBCL-PTSP demonstrated a high degree of overlap (r = .89) at the latent variable level. The best fitting, most parsimonious model was one in which the CBCL-JBD and CBCL-PTSP items identified a single latent construct, which was associated with higher parental endorsement of child suicidal behavior, and lower functioning. The CBCL-JBD profile and CBCL-PTSP scale overlap to a remarkable degree, and may be best described as measures of a single syndrome. This syndrome appears to be related to severe psychopathology, but may not conform to traditional DSM-IV classification. These results contribute to the ongoing debate about the utility of the CBCL-JBD and CBCL-PTSP profiles, and offer promising methods of empirically based measurement of disordered self-regulation in youth.

Depression, anxiety and suicidal behaviour in children and adolescents with Haemophilia

It was aimed to study the prevalence of major depressive disorder, separation anxiety disorder and suicidal behaviour in the children and adolescents with haemophilia. A total of 83 children and adolescents with haemophilia A or B aged 5-19 years old were randomly selected using systematic random sampling method. They were interviewed using the Farsi (Persian) version of Kiddie Schedule for Affective Disorders and Schizophrenia by face-to-face interview with the subjects and their primary caregivers, according to the DSM-IV diagnostic criteria. Major depressive disorder, separation anxiety disorder and suicidal behaviour were surveyed. The rate of major depressive disorder was 6.0%. Approximately 2.4% of the patients were suffering from at least five symptoms of major depression, and 4.8% were suffering from more than five symptoms of major depressive disorder. One-third of the children and adolescents were suffering from irritability. Approximately 36% of the subjects wished to die at least once during the last 6 months. Also, 6% of the subjects had thought about suicidal attempt. Approximately 4.8% of them met the criteria of separation anxiety disorder. The incidences of major depressive disorder and separation anxiety disorder were comparable to that prevalent in the thalassaemic patients. The proportion of patients with death wish was very high. The proportion of patients with suicidal thought and attempt was much lower than that in the children and adolescents with thalassaemia. Therefore, psychiatric consultation needs to be included in the management of these children.

Self-mutilation and suicidal behaviour in children and adolescents: prevalence and psychosocial correlates: results of the BELLA study

To investigate the prevalence and psychosocial correlates of suicidal behaviour in a representative sample of children and adolescents in Germany. Suicidal behaviour was assessed in the BELLA study in a sample of 2,863 families with children aged 7-17 using the corresponding questions from the child behavior check list and the youth self report. Self-reported as well as parent-reported measures of overall mental health problems, anxiety, depression, aggressive and delinquent behaviour, attention deficit-/hyperactivity as well as health-related quality of life were also administered. Self-mutilation and/or suicidal attempts within the last six months were reported by 2.9% of the adolescents 11-17 years of age. Suicidal thoughts were reported by 3.8% of the same group of adolescents. The prevalence rates reported by the parents were 1.4% for self-mutilation and/or suicidal attempts and 2.2% for suicidal thoughts. The prevalence of parent-reported self-mutilation/suicidal attempts in children below 11 years of age was very low. Youth reporting suicidal behaviour were older than youth not reporting suicidal behaviour. Children and adolescents exhibiting suicidal behaviour reported significantly more general mental health problems, depressive symptoms, anxiety, and hyperactivity as well as lower health-related quality of life. There is a strong connection between suicidal behaviour and emotional and behavioural problems, especially with symptoms of depression, anxiety and hyperactivity. The association observed between attention deficit-/hyperactivity and suicidal behaviour requires further investigation. The differences in the extent of reported suicidal behaviour in adolescents between the self- and parent-ratings and the degree of confidentiality in the collection of the data are subjects for future research.

Youth Suicide in New Mexico: A 26‐Year Retrospective Review*

Although suicidal behavior in children and adolescents is a major public health problem, large-scale research on suicide in this population is uncommon. In this study, we reviewed autopsy and field reports for all pediatric suicide cases referred to the New Mexico Office of the Medical Investigator from 1979 to 2005. The age-adjusted suicide rate was 4.8 per 100,000. Psychologic stressors and parasuicidal behavior were identified in some cases. Seventy-six percent of suicides occurred in the victim's home or yard, and 25% left a suicide note. In 26% of cases, alcohol or other drugs were detected in postmortem. Gunshot wound was the most common method overall (58%), followed by hanging (30%). Although the age-adjusted suicide rate is higher in New Mexico than nationally, the trends in the population are similar. With a solid understanding of the circumstances, it may be possible to predict, and hopefully prevent, future cases of child and adolescent death.

Treating Depressed Children With Antidepressants: More Harm than Benefit?

Since the FDA held hearings in February 2004 on the safety of antidepressants in children, there has been a great deal of controversy regarding the use of antidepressants in children, culminating in the well publicized black box warnings about increased risk of suicidal behavior in children and young adults (up to age 25) caused by these medications. Using questions that a parent might ask, the current article attempts to summarize the efficacy and safety data on the use of antidepressants in children so that psychologists, with or without prescription privileges, may be able to inform parents of young patients about the science behind this treatment. This article is based on a presentation at the 2007 American Psychological Association conference by the author in acceptance of the 2006 APAHC Bud Orgel Award for Distinguished Achievement in Research. Much of the information described in this article is drawn from the recent APA Report of the Working Group on Psychoactive Medications for Children and Adolescents. (Brown et al. 2006; available at www.apa.org/pi/cyf/childmeds.pdf ) culminating in a book by the same authors (Brown et al., Childhood mental health disorders: Evidence base and contextual factors for psychosocial, psychopharmacological, and combined interventions 2007).

In This Issue

In This Issue

Re: Suicidal Behaviour in Children and Adolescents. Part 2: Treatment and Prevention

To systematically review the treatment of suicidal behaviour in children and adolescents.After discussing the principles of treatment, we review the literature regarding adequate assessment, hospital-based services and their alternatives, and follow-up.Treatment modalities (including psychotherapy) and preventive strategies (including school-based interventions, gatekeeper and primary practitioner training, and treatment of psychiatric disorders) are considered in the light of existing evidence.The assessment of youth at risk for suicide should include attention to well-established risk factors, but prediction of risk remains difficult. Treatment of suicidal children and adolescents should be evidence-based and may include psychotherapy and psychopharmacology. Effective methods of prevention are emerging, but more research is needed.

Pathways to Suicidal Behaviors in Childhood

Path analyses were applied to test a model that includes internalizing and externalizing behavior problems as predictors of suicidal behaviors in children. Parents of an inpatient sample of boys (N=87; M age=9.81 years) rated the frequency of suicidal ideation and completed standardized measures of behavior problems. Blind raters rated the severity of the children's suicidal behaviors. Results revealed a significant direct effect for suicidal ideation on suicide attempt and for depressive symptoms on suicidal ideation. There was also a significant indirect path from impulsivity to suicidal ideation through aggressive and depressive symptoms. Clinical implications are discussed.

Suicidal Behavior in Children and Adolescents

Although many of the principles and approaches toward suicidal youth are similar to those used with suicidal adults, some key differences exist. This article highlights the main differences between adolescent and adult suicidal behavior. Screening and assessment, treatment, and legal implications related to this population are also explored.

Suicidal Behavior in Children and Adolescents.

&lt;P&gt;Although all suicides are distressing, there is something about a youth’s suicide that is particularly disturbing. Youths are seen as full of promise and potential, and an unnecessary death is perceived as an especially tragic waste. Furthermore, because children and adolescents need care from adults, a child’s suicide creates a special guilt and anguish among those who provided that care. While many of the principles and approaches toward suicidal youth are similar to working with suicidal adults, there are also some key differences. This article will highlight the main differences between adolescent and adult suicidal behavior.&lt;/P&gt;&lt;H4&gt;ABOUT THE AUTHOR&lt;/H4&gt;&lt;P&gt;Peter Ash, MD, is with the Department of Psychiatry and Behavioral Sciences, Emory University.&lt;/P&gt;&lt;P&gt;Address correspondence to: Peter Ash, Child Psychiatry, 1256 Briarcliff Rd NE, Atlanta, GA 30306, e-mail &lt;a href="mailto:peter.ash@emory.edu"&gt;peter.ash@emory.edu&lt;/a&gt;.&lt;/P&gt; &lt;P&gt;Dr. Ash has disclosed no relevant financial relationships.&lt;/P&gt; &lt;h4&gt;EDUCATIONAL OBJECTIVES&lt;/h4&gt; &lt;ol&gt; &lt;li&gt;Describe how the frequency of suicidal ideation in adolescents compares to adults.&lt;/li&gt; &lt;li&gt;Describe key differences in the assessment of suicidality in adolescents and adults.&lt;/li&gt; &lt;li&gt;Discuss how the legal status of minority affects the treatment of a suicidal child or adolescent.&lt;/li&gt; &lt;/ol&gt;