Rates of suicide in youth have increased over the last 50 years, yet our ability to predict suicidal behaviours has not significantly improved during this time. Examining predictors of suicide attempt lethality can enhance our understanding of suicidality in youth, yet research has focused on actual medical lethality (the actual danger to life resulting from a suicide attempt) rather than potential lethality (the potential for death that is associated with a suicide attempt). Thus, the aim of the present study was twofold: first, we quantified the percentage of youth for whom the severity of suicide attempt was misclassified by considering only actual lethality; second, we tested whether key variables that predict the actual lethality of suicide attempts also predict the potential lethality of suicide attempts in youth. We examined these questions in a sample of children and adolescents admitted to a psychiatric inpatient unit following a suicide attempt. Over 70% of youth who made serious suicide attempts would have been misclassified by assessments relying on only actual lethality. Although several variables relevant to the construct of actual lethality significantly predicted potential lethality (e.g., male sex, substance use disorder), others did not. In addition, we found that the subset of youth who would have been misclassified as low risk based on actual lethality had a disproportionately high need for healthcare resources due to future hospital admissions. The present study provides evidence to suggest that considering potential lethality may lead to improved detection and prediction of suicide risk in youth, and in doing so supports recent calls to broaden considerations of the lethality associated with suicide attempts.
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A parallel regression analysis examining predictors of actual medical lethality was not conducted given the low base rate of suicide attempts high in actual lethality (n = 6).
Of note, and as illustrated in Fig. 1, the suicide attempt of one individual was classified as high in actual lethality but low in potential lethality. In this case, while the attempt resulted in moderately severe physical damage for which the youth was hospitalized, without intervention the suicidal act would not have been lethal.
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This research was supported by a UBC Four Year Doctoral Fellowship (4YF) Award 6456 to EJ, a Social Sciences and Humanities Research Council (SSHRC) Grant 430-2017-00408 to JL, and a Michael Smith Foundation for Health Research Scholar Award 17713 to JL.
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
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Jopling, E., LeMoult, J., Kerns, C. et al. Potential lethality of suicide attempts in youth. Eur Child Adolesc Psychiatry (2021). https://doi.org/10.1007/s00787-021-01724-7
- Potential lethality