First Suicide Attempts in Early Adolescents: A Descriptive Outcomes Study

Background: In 2021, suicide was the second leading cause of death in early adolescent Americans ages 10-14. Research into suicidal behavior in this age group is limited. We report on prior psychiatric care, attempt method, and attempt outcomes in a cohort of 164 early adolescents accrued by first suicide attempt coming to medical attention. Methods: Our cohort constitutes a subsample from a previously reported retrospective- prospective study identified through the Rochester Epidemiology Project that recruited individuals making first suicide attempts coming to medical attention (index attempt [IA]) during a 22-year period (1/1/1986-31/12/ 07). Among 1490 all-age index attempters followed until 12/31/2010, 164 (11.0%) were aged 10-14. Results: 3/ 164 died on IA (1.8% of the cohort; two females, one male). Nearly half (72/164, 43.9%) had no prior psychiatric history. Females were less likely than males to have seen a mental health provider (P = 0.029) or been prescribed psychiatric medications (P < 0.001) prior to IA. Medication overdose was the most common attempt method in females (81/128, 63.3%), while cutting or piercing wounds were the most common method in males (13/36, 36.1%). Females were significantly more likely than males to overdose (P = 0.001). Of IA survivors, 19.9% (32/161) were initially medically hospitalized, 52.8% (85/161) were psychiatrically hospitalized- initially or in transfer-and 37.2% (60/161) were discharged without hospitalization. Conclusion: Medication overdoses accounted for over half of all IAs and were significantly more common in females. While IA mortality was low relative to older patients from the all- age-cohort, morbidity was substantial with nearly a fifth of attempts severe enough to warrant medical hospitalization and more than half initial or eventual psychiatric hospitalization. These findings emphasize the importance of both means restriction and identification of early adolescents at risk before they make their first attempt.