Suicide Trends Among Elementary School–Aged Children in the United States From 1993 to 2012 | Health Disparities | JAMA Pediatrics | JAMA Network
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Centers for Disease Control and Prevention. National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System: 1993-2012. Accessed November 13, 2014.
Centers for Disease Control and Prevention. WISQARS Leading Causes of Death Reports, National and Regional, 1999-2012. National Center for Health Statistics, National Vital Statistics System. Accessed November 14, 2014.
Jordan  JR.  Is suicide bereavement different? a reassessment of the literature.  Suicide Life Threat Behav. 2001;31(1):91-102.PubMedGoogle ScholarCrossref
Murphy  SA, Johnson  LC, Wu  L, Fan  JJ, Lohan  J.  Bereaved parents’ outcomes 4 to 60 months after their children’s deaths by accident, suicide, or homicide: a comparative study demonstrating differences.  Death Stud. 2003;27(1):39-61.PubMedGoogle ScholarCrossref
Lubell  KM, Kegler  SR, Crosby  AE, Karch  D; Centers for Disease Control and Prevention.  Suicide trends among youths and young adults aged 10-24 years, United States: 1990-2004.  MMWR Morb Mortal Wkly Rep. 2007;56(35):905-908.PubMedGoogle Scholar
Bridge  JA, Greenhouse  JB, Weldon  AH, Campo  JV, Kelleher  KJ.  Suicide trends among youths aged 10 to 19 years in the United States: 1996-2005.  JAMA. 2008;300(9):1025-1026.PubMedGoogle ScholarCrossref
Centers for Disease Control and Prevention.  Methods of suicide among persons aged 10-19 years, United States: 1992-2001.  MMWR Morb Mortal Wkly Rep. 2004;53(22):471-474.PubMedGoogle Scholar
Bridge  JA, Greenhouse  JB, Sheftall  AH, Fabio  A, Campo  JV, Kelleher  KJ.  Changes in suicide rates by hanging and/or suffocation and firearms among young persons aged 10-24 years in the United States: 1992-2006.  J Adolesc Health. 2010;46(5):503-505.PubMedGoogle ScholarCrossref
Centers for Disease Control and Prevention (CDC).  Suicide among black youths, United States: 1980-1995.  MMWR Morb Mortal Wkly Rep. 1998;47(10):193-196.PubMedGoogle Scholar
Anonymous.  From the Centers for Disease Control and Prevention: suicide among children, adolescents, and young adults. United States: 1980-1992.  JAMA. 1995;274(6):451-452.PubMedGoogle ScholarCrossref
Dervic  K, Brent  DA, Oquendo  MA.  Completed suicide in childhood.  Psychiatr Clin North Am. 2008;31(2):271-291.PubMedGoogle ScholarCrossref
Tishler  CL, Reiss  NS, Rhodes  AR.  Suicidal behavior in children younger than twelve: a diagnostic challenge for emergency department personnel.  Acad Emerg Med. 2007;14(9):810-818.PubMedGoogle ScholarCrossref
Smith  PK, Cowie  H, Blades  M.  Understanding Children’s Development.5th ed. Oxford, England: Blackwell; 2011.
Webster  DW, Vernick  JS, Zeoli  AM, Manganello  JA.  Association between youth-focused firearm laws and youth suicides.  JAMA. 2004;292(5):594-601.PubMedGoogle ScholarCrossref
Goldsmith  SK, Pellmar  TC, Kleinman  AM, Bunney  WE.  Reducing Suicide: A National Imperative. Washington, DC: National Academy Press; 2002.
Mohler  B, Earls  F.  Trends in adolescent suicide: misclassification bias?  Am J Public Health. 2001;91(1):150-153.PubMedGoogle ScholarCrossref
Phillips  DP, Ruth  TE.  Adequacy of official suicide statistics for scientific research and public policy.  Suicide & Life-Threatening Behavior. 1993;23(4):307-319.Google Scholar
Rockett  IR, Samora  JB, Coben  JH.  The black-white suicide paradox: possible effects of misclassification.  Soc Sci Med. 2006;63(8):2165-2175.PubMedGoogle ScholarCrossref
Paxton  KC, Robinson  WL, Shah  S, Schoeny  ME.  Psychological distress for African-American adolescent males: exposure to community violence and social support as factors.  Child Psychiatry Hum Dev. 2004;34(4):281-295.PubMedGoogle ScholarCrossref
Zimmerman  GM, Messner  SF.  Individual, family background, and contextual explanations of racial and ethnic disparities in youths’ exposure to violence.  Am J Public Health. 2013;103(3):435-442.PubMedGoogle ScholarCrossref
Wallace  JM, Goodkind  S, Wallace  CM, Bachman  JG.  Racial, ethnic, and gender differences in school discipline among US high school students: 1991-2005.  Negro Educ Rev. 2008;59(1-2):47-62.PubMedGoogle Scholar
Herman-Giddens  ME, Steffes  J, Harris  D,  et al.  Secondary sexual characteristics in boys: data from the Pediatric Research in Office Settings Network.  Pediatrics. 2012;130(5):e1058-e1068.PubMedGoogle ScholarCrossref
Bridge  JA, Goldstein  TR, Brent  DA.  Adolescent suicide and suicidal behavior.  J Child Psychol Psychiatry. 2006;47(3-4):372-394.PubMedGoogle ScholarCrossref
Aseltine  RH  Jr, DeMartino  R.  An outcome evaluation of the SOS Suicide Prevention Program.  Am J Public Health. 2004;94(3):446-451.PubMedGoogle ScholarCrossref
Freedenthal  S.  Racial disparities in mental health service use by adolescents who thought about or attempted suicide.  Suicide Life Threat Behav. 2007;37(1):22-34.PubMedGoogle ScholarCrossref
Gibbs  JT.  Conceptual, methodological, and sociocultural issues in black youth suicide: implications for assessment and early intervention.  Suicide Life Threat Behav. 1988;18(1):73-89.PubMedGoogle Scholar
Willis  LA, Coombs  DW, Cockerham  WC, Frison  SL.  Ready to die: a postmodern interpretation of the increase of African-American adolescent male suicide.  Soc Sci Med. 2002;55(6):907-920.PubMedGoogle ScholarCrossref
Hemenway  D, Miller  M.  Public health approach to the prevention of gun violence.  N Engl J Med. 2013;368(21):2033-2035.PubMedGoogle ScholarCrossref
The Advertising Council Inc. Through the eyes of a child: safe gun storage campaign case study. Accessed May 7, 2009.
Wyman  PA.  Developmental approach to prevent adolescent suicides: research pathways to effective upstream preventive interventions.  Am J Prev Med. 2014;47(3)(suppl 2):S251-S256.PubMedGoogle ScholarCrossref
Kellam  SG, Mackenzie  AC, Brown  CH,  et al.  The good behavior game and the future of prevention and treatment.  Addict Sci Clin Pract. 2011;6(1):73-84.PubMedGoogle Scholar
Wilcox  HC, Kellam  SG, Brown  CH,  et al.  The impact of two universal randomized first- and second-grade classroom interventions on young adult suicide ideation and attempts.  Drug Alcohol Depend. 2008;95(suppl 1):S60-S73.PubMedGoogle ScholarCrossref
Anderson  RN, Minino  AM, Fingerhut  LA, Warner  M, Heinen  MA.  Deaths: injuries, 2001. National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics.  National Vital Statistics System. 2004;52:1-86.Google Scholar
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    1 Comment for this article
    Suicidal hanging by children in India 10 years ago.
    Deepak Herald D’Souza, M.Rajesh, S.Praveen, M.G.Shivaramu, J.Kiran, S.Harish, YP Girish Chandra. | MS Ramaiah Medical College Bengaluru and Yenepoya University Mangaluru, India
    It is to congratulate the authors lead by Bridge JA et al (1) for the thought provoking paper meant for preventing suicides in children. We felt sad about the increasing suffocation suicide rate in the tender age and would add few points that will show the real situation to be even worse elsewhere in the world. Children, as young as 8 years, have committed suicide by hanging (2). Hanging is the commonest method of suicide in children in many countries (3).
    An act of hanging requires a technical preparation, compared to other methods of suicide. Therefore, the Hanging deaths in
    children are uncommon compared to adults, and they were said to comprise of 1-6% of total hanging cases in previous studies (4-5).
    10 years ago, we had done a short study of our records of childhood hanging deaths in MS Ramaiah Hospital Bangalore, India, between January 2001 and August 2004. We also found hanging as the commonest cause of suicide in children aged less than 18 years. These children comprised 10% of the total number of hanging deaths (n=523). Only one victim (male; 9 years) had committed suicide by hanging in the category of below 10 years.
    Preventing suicides in children should be done by multiple strategic methods. Thankfully, many countries do not have to tackle the root causes such as poverty and illiteracy. We strongly suggest the inculcation of positive approach in children from the very beginning. Suicidal hanging can be prevented in depressed children by giving personal attention till the child overcomes that depression.


    1. Bridge JA, Asti L, Horowitz LM, Greenhouse JB, Fontanella CA, Sheftall AH, Kelleher KJ, Campo JV. Suicide Trends Among Elementary School-Aged Children in the United States From 1993 to 2012. JAMA Pediatr. 2015;169(7):673-7.
    2. Pakis I, Yayci, Nesime, Karapirli, Mustafa, Yildiz, Nicel, Gunce, Elif, Yilmaz, Riza and Polat, Oguz () 'Childhood deaths due to suicide', Australian Journal of Forensic Sciences. 2010;42(3):191-197.
    3. Soole R, Kõlves K, De Leo D. Suicide in Children: A Systematic Review. Arch Suicide Res. 2015;19(3):285-304.
    4. Davison A, Marshall TK. Hanging in Northern Ireland--a survey. Med Sci Law. 1986 Jan;26(1):23-8.
    5. Wyatt JP, Wyatt PW, Squires TJ, Busuttil A. Hanging deaths in children. Am J Forensic Med Pathol. 1998;19(4):343-346.
    Original Investigation
    July 2015

    Suicide Trends Among Elementary School–Aged Children in the United States From 1993 to 2012

    Author Affiliations
    • 1The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
    • 2Department of Pediatrics, The Ohio State University College of Medicine, Columbus
    • 3Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
    • 4Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
    • 5Department of Statistics, Carnegie Mellon University, Pittsburgh, Pennsylvania
    • 6Department of Psychiatry, The Ohio State University College of Medicine, Columbus
    JAMA Pediatr. 2015;169(7):673-677. doi:10.1001/jamapediatrics.2015.0465

    Importance  Suicide is a leading cause of death among school-aged children younger than 12 years but little is known about the epidemiology of suicide in this age group.

    Objective  To describe trends in suicide among US children younger than 12 years by sociodemographic group and method of death.

    Design, Setting, and Participants  Period trend analysis of national mortality data on suicide in children aged 5 to 11 years in the United States from January 1, 1993, to December 31, 2012. Data were analyzed per 5-year periods, between 1993 to 1997 and 2008 to 2012.

    Main Outcomes and Measures  Number of suicide deaths and crude suicide rates. Period trends in rates of suicide were estimated using negative binomial regression incidence rate ratios (IRRs).

    Results  The overall suicide rate among children aged 5 to 11 years remained stable between 1993 to 1997 and 2008 to 2012 (from 1.18 to 1.09 per 1 million; IRR = 0.96; 95% CI, 0.90-1.03). However, the suicide rate increased significantly in black children (from 1.36 to 2.54 per 1 million; IRR = 1.27; 95% CI, 1.11-1.45) and decreased in white children (from 1.14 to 0.77 per 1 million; IRR = 0.86; 95% CI, 0.79-0.94). The overall firearm suicide rate (IRR = 0.69; 95% CI, 0.57-0.85) and firearm suicide rate among white boys (IRR = 0.72; 95% CI, 0.59-0.88) decreased significantly during the study. The rate of suicide by hanging/suffocation increased significantly in black boys (IRR = 1.35; 95% CI, 1.14-1.61), although the overall change in suicide rates by hanging/suffocation or other suicide methods did not change during the study.

    Conclusions and Relevance  The stable overall suicide rate in school-aged children in the United States during 20 years of study obscured a significant increase in suicide incidence in black children and a significant decrease in suicide incidence among white children. Findings highlight a potential racial disparity that warrants attention. Further studies are needed to monitor these emerging trends and identify risk, protective, and precipitating factors relevant to suicide prevention efforts in children younger than 12 years.