1 table omitted
During 1994-1999, at least 126 students carried out a homicide or suicide
that was associated with a private or public school in the United States.1 Although previous research has described students
who commit school-associated homicides, little is known about student victims
of suicide. To describe the psychosocial and behavioral characteristics of
school-associated suicide victims, CDC analyzed data from school and police
officials. The results of that analysis indicated that, among the 126 students
who carried out school-associated homicides or suicides, 28 (22%) died by
suicide, including eight who intentionally injured someone else immediately
before killing themselves. Two (7%) of the suicide victims were reported for
fighting and four (14%) for disobedient behavior in the year preceding their
deaths; none were associated with a gang. However, potential indicators of
suicide risk such as expressions of suicidal thoughts, recent social stressors,
and substance use were common among the victims. These findings underscore
the need for school staff to learn to recognize and respond to chronic and
situational risk factors for suicide.
Included in this analysis were suicides for which the victim was an
elementary or secondary school student and the death occurred during July
1, 1994–June 30, 1999, in one of the following settings: (1) on the
grounds of an operating public or private elementary or secondary school in
the United States, (2) while the victim was en route to or from regular school
sessions, or (3) while the victim was attending or traveling to or from an
official school-sponsored event. Cases of school-associated suicide were identified
through a systematic search of two computerized newspaper and broadcast media
databases (i.e., Lexis-Nexis and Dialog). Data on the victims were collected
through structured and standardized interviews with school and police officials
and by reviewing police reports.
The 28 school-associated suicide victims included four students who
first committed homicide and four other students who first inflicted nonfatal
injuries on others. Among the suicide victims, 22 (78%) were males, 22 (78%)
were non-Hispanic whites, and 17 (60%) lived with two parents (Table). Twenty-six
(93%) of the suicide victims used firearms.
Eleven (39%) students were reported to be weekly users of alcohol or
drugs, and five (18%) were reported intoxicated at the time of their suicides.
Six (21%) of the students had a history of criminal charges; four (14%) had
been reported for disobedience; two (7%) had been reported for fighting with
peers; and no student was a known gang member. The majority (61%) of the students
were involved in extracurricular activities. A total of 16 (57%) of the students
had expressed suicidal thoughts, including 10 who confided in a peer. Eight
(29%) students had experienced a romantic breakup and nine (32%) a household
disruption such as moving or having a household member move out.
J Kaufman, PhD, Dept of Sociology, Univ of Miami, Florida. W Modzeleski,
MS, Office of Safe and Drug Free Schools Program, U.S. Dept of Education.
T Feucht, PhD, National Institute of Justice, U.S. Dept of Justice. TR Simon,
PhD, M Anderson, MD, K Shaw, MPH, I Arias, PhD, Div of Violence Prevention,
National Center for Injury Prevention and Control; L Barrios, DrPH, Div of
Adolescent and School Health, National Center for Chronic Disease Prevention
and Health Promotion, CDC.
The need for safe schools has prompted considerable interest in understanding
and preventing all types of lethal school-associated violence. The finding
that 22% of students who carried out such violence took their own lives indicates
that a sizeable proportion of lethal school-associated violence was self-directed.
In addition, the finding that approximately one in four suicide victims injured
or killed someone else immediately before their suicide suggests an overlap
between risk for committing school-associated homicide and risk for suicide.
Efforts to prevent incidents of lethal school-associated violence should address
youth suicidal ideation and behavior.
Suicide-prevention efforts are needed not only to address the risk for
school-associated violence, but also to reduce the much larger problem of
self-directed violence among adolescents overall. In 2001, suicide was the
third leading cause of death in the United States among youths aged 13-18
years, accounting for 11% of deaths in this age group.2 In
2003, approximately one in 12 high school students in the United States reported
attempting suicide during the preceding 12 months.3 Data
from Oregon indicate that approximately 5% of adolescents treated in hospitals
for injuries from a suicide attempt made that attempt at school.4
The finding that the majority of students who were school-associated
suicide victims were involved in extracurricular activities suggests that
these students could be familiar to school staff who might recognize warning
signs. Although these students were unlikely to stand out (e.g., by fighting
or involvement in gangs) in the manner of those who commit school-associated
homicides,1 other established risk factors
for suicidal behavior were common (e.g., expression of suicidal thoughts,
recent household move, and romantic breakup). These findings support the need
for school-based efforts to identify and assist students who describe suicidal
thoughts or have difficulty coping with social stressors. School-based prevention
efforts are likely to benefit from school officials working closely with community
mental health professionals to enhance the abilities of school counselors,
teachers, nurses, and administrators to recognize and respond to risk factors
for suicide. CDC's School Health Guidelines recommend that school personnel
be provided with regular staff development opportunities to prepare them to
help prevent suicide.5 In 2000, only 15%
of required health education courses were taught by teachers who received
staff development on suicide prevention during the preceding 2 years, suggesting
that additional opportunities for staff development are needed.6
The findings that one in four of the school-associated suicides were
preceded by a recent romantic breakup and nearly one in five suicide victims
were under the influence of drugs or alcohol at the time of their deaths underscore
the potential importance of situational risk factors. Youth suicidal behavior
often is an impulsive response to circumstances rather than a wish to die.7 Efforts to help students cope with stressors and
avoid substance abuse are important elements of suicide-prevention strategies.8
The findings in this report are subject to at least four limitations.
First, because events were identified from news media reports, any event not
reported in the media was excluded; the nature of the events might have resulted
in an undercount of the number of school-associated suicides. Second, certain
estimates might be unstable because of the small cell sizes. Third, the data
are from secondary sources and are subject to recall error or bias; the nature
of these events might have influenced responses. Finally, the number of school-associated
suicide victims reported with each characteristic might be undercounted, and
the percentages of students with these characteristics might not be representative
of all students who died by suicide during 1994-1999.
Prevention of youth suicide is a critical public health priority. The
findings in this report underscore the need to "develop and implement safe
and effective programs in educational settings for youth that address adolescent
distress, crisis intervention and incorporate peer support for seeking help"
as described in the Surgeon General's Call to Action to
Prevent Suicide, 1999.8
School-Associated Suicides—United States, 1994-1999. JAMA. 2004;292(12):1423-1424. doi:10.1001/jama.292.12.1423