Researchers identified 5 distinct classifications of youth suicide, revealing that nearly half of cases had no prior clinical contact or documented risk.
Researchers from Children’s Hospital Colorado have identified 5 classifications of youths who have died by suicide, publishing their findings in the Journal of the American Academy of Child and Adolescent Psychiatry.1
The data highlighted no clinical contact or known risk of suicide in nearly 50% of youths who died by suicide. According to investigators, this knowledge is vital for recommending suicide interventions among this population.
“In order to help kids now, we need to dig into the mountain of data available to us to learn about youth who are at risk of dying by suicide,” said Joel Stoddard, MD, MAS, child and adolescent psychiatrist at Children’s Colorado. “Not every child who dies by suicide has the same story.”
The study was conducted to determine warning signs of suicide in youth and identify effects interventions. Participants included youths aged 10 to 17 years with a death by suicide recorded in the US National Violent Death Reporting System. Using this data, investigators defined 5 key classifications of suicide:
Youths in the crisis category experienced an acute crisis related to school or their personal lives. Suicidal thoughts were not present in these patients before the crisis. Since the crisis may lead to a medical emergency, investigators noted this group is the most likely to be familiar with hospital emergency providers.
In the disclosing group, patients shared their suicidal thoughts with another person. Investigators highlighted the importance of trusted adults paying attention and taking the next appropriate step, alongside the need for improved education about available interventions.
The hidden group included youths with no recorded risk factors. Additionally, these patients do not often interact with the health care system and were usually identified when presenting for other physical symptoms.
Youths frequently utilizing the mental health system, often for chronic crises and familial challenges, were classified as identified. In comparison, those identified as having died from suicide by coroner’s reporting with no other information were classified as surveillance.
To prevent suicide in these youths, investigators highlighted research-driven recommendations by Children’s Colorado. These include implanting universal suicidal risk screening, as a lack of contact with the mental health system is common in youths with a recorded death by suicide.
Safe firearm storage and counseling are also vital. Access to firearms in the home has been linked to an increased risk of youth suicide, highlighting the need to have conversations about gun safety and firearm access. According to Children’s Colorado, these discussions should be integrated into routine primary care.
The efficacy of crisis-oriented outreach was also highlighted, as this method may be a cause of lower crisis-related deaths in Colorado, according to investigators. Steps can also be taken at the state level, including strengthened death scene investigation protocols and reporting standards. This can inform research and guide future interventions.
Investigators also stressed the need to follow-up with youth already in treatment. Finally, future research will determine how artificial intelligence might be used to identify patterns linked to suicide attempts, potentially saving more lives.
“This research underscores the importance of early identification because by knowing how others have passed away, we can work to prevent this harm in the future,” said Stoddard.
The importance of psychosocial screening for suicide prevention was highlighted by Robert M. Cavanaugh, Jr, MD, and Karen L. Teelin, MD, in the October 2025 issue of Contemporary Pediatrics.2 This can be accomplished using the Home, Education, Abuse, Drugs, Safety, Friends, Image, Recreation, Sexuality, and Threats (HEADS FIRST) checklist.
The HEADS FIRST checklist identifies initial questions for each domain, with additional questions following based on patient response. This may reveal information about an adolescent and indicate issues that need to be addressed. However, further research is needed to evaluate the efficacy of this checklist in pediatric clinical practices.
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