Risk Factors and Warning Signs for Youth Suicide: Smoking, Drinking, Marijuana, Family Problems, Sexual Orientation, and School-Performance

Why do kids kill themselves and what are some of the warning signs? Although suicide is the third leading cause of death for youth, risk factors and preventative measures are not well understood by the people who are best able to help: parents, teachers, and school nurses. Studies reveal some predictable findings, and some surprising risk factors for suicide.

Researchers at the Yale Child Study Center and several other universities interviewed with more than 1200 youth between 9 and 17 living in Connecticut, Georgia, New York, and Puerto Rico, and their adult caretakers.[1] The 2001 study used a survey designed by the National Institute of Mental Health.

They found that 5% of the youth reported imagining committing suicide within the past 6 months even though none had a history of suicide attempts. Three percent of the youth reported that they had attempted suicide at least once in their lives.

Youth who attempted suicide differed from those who thought about suicide in several ways. Those who attempted suicide were more likely to have experienced numerous stressful life events, to have become sexually active, to have smoked more than one cigarette per day, and to have ever smoked marijuana or hashish.

The researchers then combined the youth that had attempted suicide with the youth that had merely imagined doing it, and compared this combined group with other kids their age. Compared to their classmates, the kids who considered or attempted suicide were more likely to report stressful life events, sexual intercourse, having smoked marijuana, having been drunk in the past 6 months, smoking more than one cigarette each day, anxiety or depression, and having been in a fight that included punching or kicking in the previous year. Their parents were more likely to report a poor family environment, parental history of a psychiatric disorder, low parental monitoring, and their child’s lack of competence (such as being unable to follow directions), poor social skills, and lack of friends. These differences were significant regardless of student’s age, race, sex, or family income.

Interestingly, the researchers did not find a link between suicide and problems such as having a non-intact family, marital discord, or parents’ use of physical discipline. In previous studies, these risk factors have been linked to youth suicide.

The authors expressed surprise that even very low levels of tobacco, marijuana, or alcohol use seemed to increase the risk of suicidal thoughts or attempts. This low-level drug use may be a symptom rather than a cause. In other words, the anxiety, depression, and fights that seem to increase the risk of suicidal thoughts or suicide attempts may also lead to low level use of tobacco, marijuana or alcohol. Previous research suggests that sometimes youth and adults use alcohol or drugs to help them cope with mental problems; unfortunately, those problems often become worse as a result.

It has become increasingly apparent that sexual orientation is related to suicide risk in youth. A June 2011 report from the U.S. Department of Health and Human Services concluded that suicide attempts necessitating treatment by a doctor or nurse are higher among gay or lesbian students in grade 9-12 than among heterosexual students. Whereas only 3% of heterosexual students reported attempted suicide, 7% of gay or lesbian students did so. This is attributed to the social difficulties they face, such as stigmatization, discrimination, and rejection.[2]

A 2007 study conducted by the University of Washington School of Nursing demonstrated that youth experiencing school difficulties are at a vastly increased risk of suicide. Using questionnaires and face-to-face interviews, researchers studied 730 students aged 14-21 years old at seven high schools across the northwest and southwest United States. They found that 40% of youth experiencing school difficulties had thoughts of suicide. In addition, they discovered that “self-efficacy,” (self-esteem and belief in one’s ability to succeed and control situations), as well as family support reduced the risk of suicide. This study confirmed what other studies have also found: sex is an important factor.[3] Males are four times more likely to commit suicide than females, although females are more likely to attempt it.[4]

These studies provide tips that may be useful to those who want to help prevent youth suicide: even relatively infrequent drinking, drug, and cigarette use, as well as other more obvious problems, can be warning signs of potential suicidal thoughts or attempts. In order to decrease the number of youth suicide attempts, those in a position to help must recognize the risk factors. Because many of these factors are clearly evident in the school setting and are often school-related, professionals such as teachers and nurses must take action.

All articles are reviewed and approved by Dr. Diana Zuckerman and other senior staff.

  1. Psychosocial and Risk Behavior Correlates of Youth Suicide Attempts and Suicidal Ideation. Robert King, MD, Mary Schwab-Stone, MD, Alan Flisher, PhD, and others. Journal of the American Academy of Child and Adolescent Psychiatry, Vol 40, No 7, July 2001, 837-46.
  2. Sexual Identity, Sex of Sexual Contacts, and Health-Risk Behaviors Among Students in Grades 9-12. Youth Risk Behavior Surveillance, Selected Sites, United States, 2001-2009. US Department for Health and Human Services. Center for Disease Control and Prevention. June 2011.
  3. Suicide risk and protective factors among youth experiencing school difficulties. Elaine Walsh and Leona L. Eggert. International Journal of Mental Health Nursing, Vol 16, 2007, 349-359.
  4. Facts and Figures by Gender. American Foundation for Suicide Prevention.