To the Editor The article by Fontanella et al1 examining suicide among Medicaid-enrolled youths is an excellent demonstration of the major clinical problems created by the inadequacies of the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) paradigm for the classification of mental disease. This research would be more useful in the primary care clinic if it documented the frequency (as a diagnosis or comorbidity) of child abuse or neglect (CAN) in addition to DSM-5 symptom complexes, thus significantly enhancing best-practices treatment and social intervention. This research uses International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision following the DSM-5 paradigm. These systems do also specifically identify child abuse or trauma diagnoses: International Classification of Diseases, Ninth Revision codes 995.50-995.59 and E967.0-967.9 and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes T74.1-T74.9, Z61.4-Z61.6, Y07.9, and F43.1. The article is unclear whether these diagnoses were enumerated in the index cases. Additionally, the treating clinicians, restricted by the DSM-5, may have undercoded these conditions. Thus, this information is absent from Table 1 and the discussion. Knowledge about prior or ongoing CAN could have heightened sensitivity to suicide risk and increased prevention and would inform future practice.