Historical review

Until the late 1950s, knowledge about youth suicide was drawn from unrepresentative case reviews, reviews of the demography of suicide drawn from death certificate data, and speculation about dynamics. The late 1950s saw the first systematic psychological autopsy study among adults that demonstrated the importance of psychiatric disorder as a proximal cause of most suicides. ty This was followed by similar studies on children and adolescents,(2,34 and confirming the association in adolescence. Starting in the mid-1960s, the incidence of suicide in young males began to rise in many countries. (6) The rate of increase eventually stabilized in the late 1980s and, in many countries, is now showing signs of falling.(7) These changes stimulated efforts to develop methods of preventing youth suicide. (8,,9.,10 and l1

A good deal is now known about which teenagers commit suicide, less about who attempts it, and very little about the optimal management of suicidal adolescents. The number of randomized controlled trials designed to assess different forms of treatment is exceedingly small, and many suggestions for clinical management are based on anecdotal accounts rather than on findings from well-designed experimental trials.

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