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Madelyn S. Gould, PhD, MPH; Prudence Fisher, MS; Michael Parides, PhD; Michael Flory, PhD; David Shaffer, MD

Arch Gen Psychiatry. 1996;53(12):1155-1162.

Abstract
Background
Few psychosocial risk factors for completed suicide in children and adolescents have been studied systematically. The present study was designed to examine the environmental, social, and familial characteristics of a large representative sample of child and adolescent suicides.

Methods
A case-control, psychological autopsy of 120 of 170 consecutive suicides younger than 20 years and 147 community age-, sex-, and ethnically matched control participants in the greater New York, NY, area.

Results
There was a significant independent impact of the psychosocial factors on increasing suicide risk among children and adolescents, beyond that risk attributable to psychiatric illness. The most notable risks were derived from school problems, a family history of suicidal behavior, poor parent-child communication, and stressful life events. Sex, ethnicity, and age modified the relationships of a few of the psychosocial factors.

Conclusions
Socioenvironmental circumstances add significantly to a teenager's risk of suicide. The overall effect size on increasing suicide risk of the psychosocial factors is comparable with that for diagnostic factors, highlighting the importance of considering socioenvironmental factors when assessing suicide risk.

Author Affiliations
From the Division of Child Psychiatry, Columbia University, College of Physicians and Surgeons/New York State Psychiatric Institute, and the Division of Epidemiology, Columbia University School of Public Health, New York, NY.

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