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Suicide is the second leading cause of death for adolescents between the ages 10 and 19 in the USA, accounting for 2744 deaths in 2019. The incidence has been steadily rising in the USA, and 5.1% of male and 9.3% of female high school students in the USA report a suicide attempt in the past year. Suicide attempts represent less than 5% of injuries treated at trauma centers in part because of the high lethality of self-inflicted firearm injuries and asphyxiation—the two leading mechanisms of suicide death in this age group, as many die prior to receiving medical care. In addition, many adolescents that present with self-inflicted injuries or suicidal behaviors are often treated in the emergency department (ED) and may not be encountered by the trauma team. However, in a 2-year period, trauma centers participating in the National Trauma Data Bank cared for 3783 adolescents with a suicide attempt, 13% of which died from their injuries. Those that are admitted often have higher injury severity, healthcare utilization, and mortality compared to other intents of injury, and those that have previous attempts are at risk of future suicide attempts. What we often encounter—far more than suicide attempts—are adolescents with mental illnesses and other risk factors for suicide at the time of and after injury. Given this, it is imperative that trauma centers and healthcare providers understand the epidemiology, risk factors, warning signs, and strategies to identify adolescents at risk, refer them to evidence-based mental health services, and support patients and their families.

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authors: Ashley B. Hink, Xzavier Killings, Apurva Bhatt, Leigh E. Ridings, Annie Lintzenich Andrews

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