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    Original Investigation
    October 30, 2019

    Prevalence, Onset, and Course of Suicidal Behavior Among Adolescents and Young Adults in Germany

    Author Affiliations
    • 1Behavioral Epidemiology, Technische Universität Dresden, Dresden, Germany
    • 2Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
    • 3Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
    • 4Center for Clinical Epidemiology and Longitudinal Studies, Technische Universität Dresden, Dresden, Germany
    JAMA Netw Open. 2019;2(10):e1914386. doi:10.1001/jamanetworkopen.2019.14386
    Key Points español 中文 (chinese)

    Question  How frequently and when do suicidal ideation, plan, and attempt emerge in adolescence and young adulthood?

    Findings  In a cross-sectional, epidemiological study of 1180 adolescents and young adults from a random community sample in Germany, 10.7%, 5.0%, and 3.4% of participants reported lifetime suicidal ideation, plan, and attempt, respectively. The cumulative incidence of suicidal behavior increased after age 10 years more strongly among female than male participants, and the transition from ideation to action occurred mostly during the same year.

    Meaning  Adolescence and young adulthood are critical developmental periods for the onset of suicidal behavior, with a short time for targeted interventions to disrupt the ideation-to-action pathway.


    Importance  Suicidal behavior is a leading cause of death among adolescents and young adults. In light of the ideation-to-action framework, the delineation of frequency and temporal characteristics of such behavior during this developmental period is crucial.

    Objectives  To provide lifetime and 12-month prevalence estimates of suicidal behavior, including ideation, plan, and attempt, in adolescents and young adults of the general population, and to provide information about age at onset, temporal characteristics of suicidal behavior, including duration (number of years between onset and last occurrence) and frequency (number of episodes), and transition patterns across suicidal behaviors.

    Design, Setting, and Participants  A cross-sectional epidemiological study was conducted in a random community sample of 1180 adolescents and young adults aged 14 to 21 years assessed in 2015 to 2016 in Dresden, Germany. Data analysis was performed from October 2018 to March 2019.

    Main Outcomes and Measures  Lifetime and 12-month suicidal behavior (ideation, plan, and attempt) were assessed with a standardized diagnostic interview (Munich-Composite International Diagnostic Interview) by trained clinical interviewers. The onset, frequency, and duration of suicidal behavior were assessed by questionnaire.

    Results  Of the 1180 participants (495 male [weighted percentage, 51.7%]; mean [SD] age, 17.9 [2.3] years), 130 participants (10.7%; 95% CI, 9.0%-12.8%), 65 participants (5.0%; 95% CI, 3.9%-6.5%), and 41 participants (3.4%; 95% CI, 2.4%-4.7%) reported lifetime suicidal ideation, plan, and attempt, respectively. Any lifetime suicidal behavior was reported by 138 participants (11.5%; 95% CI, 9.7%-13.7%). Age-specific cumulative incidence estimates indicated an increase in suicidal behavior during adolescence, starting at age 10 years (<1%), increasing slightly until the age of 12 years (2.2%), and then increasing sharply thereafter until age 20 years (13.5%). There were different patterns among female and male participants for ideation, plan, and attempt, with an overall higher incidence among female participants for ideation (hazard ratio, 1.51; 95% CI, 1.02-2.22; P = .04), for plan (hazard ratio, 3.31; 95% CI, 1.72-6.36; P < .001), and, among those older than 14 years, for attempt (hazard ratio, 3.07; 95% CI, 1.11-8.49; P = .03). Of those with suicidal ideation, 66.0% reported persistent or recurrent ideation over more than 1 year with 75.0% reporting more than 1 episode. Of the participants with lifetime suicidal ideation, 47.0% reported a suicide plan and 23.9% reported a suicide attempt. The transition to suicide plan or attempt occurred mainly in the year of onset of suicidal ideation or plan; of those who transitioned, 74.9% transitioned from ideation to plan, 71.2% transitioned from ideation to attempt, and 85.4% transitioned from plan to attempt in the same year.

    Conclusions and Relevance  There is an urgent public health need for timely identification of suicidal behavior in adolescents and young adults to terminate persistent or recurrent suicidal tendencies and to interrupt the ideation-to-action transition.