Sociodemographic and Clinical Characteristics of Adolescents Following Suicide Attempts: A Single-Center Study From Türkiye
Article information
Abstract
Objective
Suicidal behavior among adolescents has become increasingly prevalent in recent years, positioning suicide as one of the leading causes of death in this age group worldwide. Despite this growing public health concern, country-specific data remain limited, particularly in Türkiye. This study aimed to examine the sociodemographic and clinical characteristics of adolescents referred to psychiatric services following a suicide attempt in Türkiye.
Methods
We enrolled adolescents (12–18 years) who presented to the Pediatric Emergency Department after a suicide attempt and were subsequently referred to our clinic. Participants completed a Sociodemographic Data Form and underwent the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version interview to assess lifetime psychiatric diagnoses.
Results
Among the 60 participants, 86.7% were female and 13.3% were male. The mean age was 184.7±13.6 months (range: 144–211 months). Two-thirds (66.7%) met criteria for at least one psychiatric disorder; major depressive disorder was most prevalent (41.7%). The predominant method of attempt was medication ingestion, and family conflict was identified as the leading precipitant (56.7%). A history of prior suicide attempts was reported by 40%, and 33.3% had a family history of suicide. Notably, 70% had engaged in non-suicidal self-harming behavior (SHB) before their attempt.
Conclusion
Suicide attempts peak during middle adolescence, and female adolescents are at higher risk. Clinicians should monitor warning signs such as a prior history of SHB. Given the high prevalence of psychiatric disorders in both these adolescents and their parents, early identification and intervention are essential to prevention.
INTRODUCTION
Suicidal behavior—which encompasses both suicide attempts and completed suicides—is not classified as a medical illness, yet it represents a critical public-health concern. Over the past decade, it has emerged as a clinical condition demanding urgent attention from international health communities [1]. Each death by suicide constitutes a personal tragedy and profoundly affects the bereaved family and social networks [2]. As our understanding of suicide risk factors has evolved, a “suicide spectrum” framework has been proposed to differentiate: suicidal ideation (active/planned vs. passive/unplanned); suicide attempts, defined as self-harm with or without intent to die that does not result in death; suicidal behavior, which may or may not be fatal; suicide itself, the act resulting in death [3].
In the United States, suicide is the second leading cause of death among 10–19-year-olds [4], and rates have risen steadily in recent years. A survey of US high-school students found that 5.1% of males and 9.3% of females attempted suicide in the previous year [5]. Although the etiology of adolescent suicide is complex, rates of both suicidal ideation and attempts increase markedly during adolescence [6], with many individuals transitioning from thoughts to actions within 1 to 2 years of first ideation [7]. Contributing factors include improved capacity for suicide planning, underdeveloped emotional-regulation and problem-solving skills, and higher rates of mood and substance-use disorders [8]. The coronavirus disease-2019 pandemic has further exacerbated this trend globally through indirect stressors—separation, bereavement, disrupted schooling, and reduced social support [9-12]—and recent data reveal spikes in attempts and deaths across regions such as the US, UK, and South Asia [13,14].
While adolescent suicide is a global concern, epidemiological patterns and sociocultural risk factors vary significantly by country. In Türkiye, national data remain limited: a recent analysis of suicide deaths from 2004 to 2023 found that hanging and firearms were the most frequent methods, with family discord emerging as the leading precipitating factor among females [15]. Further, retrospective data from a Turkish province indicated that females predominate in adolescent suicide, with self-poisoning being more common among girls and hanging and firearms more frequent among boys. Additionally, emergency department-based comparisons between Turkish and US adolescents showed that 78% of Turkish suicide attempters were female, and medication ingestion was the primary method [16]. Therefore, our study addresses a critical gap in Türkiye-specific research on adolescent suicide attempts, contextualizing the demographic and clinical profiles within unique national trends.
This study aims to characterize the sociodemographic profiles of adolescents following a suicide attempt, describe the nature of their attempts, and determine the prevalence of psychiatric disorders in this population.
METHODS
Study design
This study was approved by the Karabük University Ethics Committee for Non-Interventional Clinical Research (Decision No. 2024/1933, 15 October 2024). Between October 2024 and March 2025, adolescents aged 12–18 years who presented to the Emergency Department of Karabük University Education and Research Hospital following a suicide attempt and were subsequently referred to the Child and Adolescent Psychiatry Clinic were enrolled. A suicide attempt was operationally defined as “a self-inflicted, potentially injurious behavior with a non-fatal outcome, for which there is evidence of intent to die,” consistent with definitions proposed by Nock et al. [17] and widely accepted in suicidology. This intent could be explicit (e.g., stated by the adolescent) or implicit (e.g., inferred from the circumstances or absence of alternative motives). Determination was based on the adolescent’s self-report during the psychiatric assessment and corroborated by medical and clinician records.
Inclusion criteria were as follows: 1) age between 12 and 18 years; 2) presentation to the emergency department due to a suicide attempt (defined as a self-initiated behavior with the intent to die, regardless of medical severity); 3) sufficient cognitive and verbal capacity to participate in a structured psychiatric interview; and 4) provision of informed consent by both the adolescent and a legal guardian.
Exclusion criteria included: 1) a diagnosed intellectual disability (IQ <70 or special education placement); 2) presence of active psychosis; 3) refusal to participate; and 4) acute intoxication or severe medical instability preventing interview.
All participants underwent a structured psychiatric evaluation using the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL). The interviews were conducted by a child and adolescent psychiatry specialist with at least 5 years of clinical experience, certified in the administration of the K-SADS-PL. Interviews were held within the first 7 days following medical stabilization, typically during outpatient follow-up visits. All participants completed a Sociodemographic Data Form, which solicited information on date of birth, sex, family structure, education level, and the antecedents and consequences of the suicide attempt, including psychiatric treatment history, hospitalizations, attempt circumstances, and illness duration. To ascertain lifetime psychiatric diagnoses per Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria, each adolescent underwent the K-SADS-PL interview. Although the DSM-5 is the most current diagnostic framework, the Turkish version of the K-SADS-PL employed in this study is validated only according to DSM-IV criteria. At the time of the study, no DSM-5-compatible, Turkish-validated version of the K-SADS-PL was available. Therefore, to ensure diagnostic reliability and validity, DSM-IV criteria were used.
Instruments
K-SADS-PL
A semi-structured diagnostic interview, adapted from the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children–Present Episode version [18] and finalized by Kaufman et al. [19]. It assesses mood, psychotic, anxiety, behavioral, substance-use, and other disorders through specific modules and sub-modules, and includes a general children’s assessment scale. The Turkish version’s validity and reliability were established by Gökler et al. [20]. In this study, the Turkish version validated by Gökler et al. [20] was used. Each interview lasted approximately 45–60 minutes and included both child and parent components. Final diagnoses were made by the evaluating clinician based on all available information.
Sociodemographic Data Form
The Sociodemographic Data Form was a structured questionnaire developed by the research team specifically for this study and administered during the initial psychiatric evaluation. The form included two main sections. The first section gathered basic demographic information such as the adolescent’s age, sex, school type and grade level, perceived academic performance, number of siblings, family type (nuclear or extended), parental marital status, parental education and employment status, family income level, and the presence of any chronic medical or psychiatric illness in parents. The second section focused on suicide-related variables and included questions regarding previous suicide attempts, family history of suicide, the method and location of the most recent attempt, the adolescent’s stated intent, triggering factors (e.g., family conflict, peer problems, academic pressure), help-seeking behavior after the attempt, emotional response to the attempt (e.g., regret or relief), history of non-suicidal self-harming behavior (SHB), and prior psychiatric treatment or follow-up. The information was collected through face-to-face interviews with both the adolescent and at least one parent or legal guardian prior to the diagnostic assessment.
Statistical analysis
Data were analyzed using IBM SPSS Statistics ver. 27.0 (IBM Corp.). Continuous variables are reported as mean±standard deviation; categorical variables as frequencies and percentages. Associations among categorical variables were tested via chi-square or Fisher’s exact test, with two-tailed significance set at p<0.05.
RESULTS
The mean age of the adolescents was 184.68±13.64 months (range: 144–211 months). Of the participants, 52 (86.7%) were female and 8 (13.3%) were male. The mean ages of their mothers and fathers were 42.28±6.27 years and 47.29±6.27 years, respectively. Sociodemographic characteristics of the participants are summarized in Table 1.
Sociodemographic characteristics of the participants
Of the participants, 52 (86.7%) lived in nuclear families and 8 (13.3%) in extended families; 41 (68.3%) had parents living together, while 19 (31.7%) came from divorced families. Detailed family characteristics are presented in Table 2.
Familial sociodemographic characteristics of the participants
The characteristics of the participants related to suicide attempts and suicide risk factors are shown in Table 3. The most frequently chosen method of suicide attempt was ingesting medication (60.0%). The most common trigger for the suicide attempt was family conflict (56.7%). Among those who attempted suicide, 70.0% had a history of SHB. Additionally, 50.0% of the participants had a history of psychiatric follow-up.
Characteristics of the participants related to suicide attempts and suicide risk factors
The relationship between SHB and previous suicide attempts with various variables is shown in Table 4. According to this, individuals with low academic performance had a significantly higher history of SHB compared to those with high academic performance (p=0.008). Among those whose parents lived together, there was a significantly higher history of previous suicide attempts compared to those with divorced parents (p=0.041).
The relationship between SHB and previous suicide attempt with various variables
DISCUSSION
This study examined the individual and familial profiles of adolescents after a suicide attempt, as well as the characteristics of their attempts. Participants ranged from 12.0 to 17.6 years of age (mean, 184.7±13.6 months). Females comprised 86.7% of the sample, and males 13.3%, indicating a markedly higher frequency of attempts among girls. Although adolescent girls report higher rates of suicidal ideation and attempts, boys exhibit higher suicide mortality—a phenomenon known as the “gender paradox” in suicidal behavior [21-23]. This disparity is largely attributed to the more lethal methods males tend to employ [24]. National data mirror these findings: one Turkish study found that 92.1% of youth who attempted suicide were female [25]. Internationally, attempt rates among adolescent girls are roughly double those of boys in China, India, and Nepal, and nearly triple in Bangladesh [26]. In the United States, high-school girls report higher rates of suicidal thoughts (19.3% vs. 12.5%), planning (15.0% vs. 10.8%), and attempts (9.8% vs. 5.8%) compared to boys.27 Our results reinforce these sex-based patterns in adolescent suicidal behavior.
The mean age of our participants was 15 years and 4 months. Middle and late adolescence are periods of heightened suicide risk. Proposed contributing factors include increased substance use, more frequent depressive symptoms, and sensation-seeking and risk-taking behaviors [28-30]. Inadequate coping skills and poor management of these challenges further elevate the likelihood of suicide attempts [31]. Additionally, suicidal ideation during middle and late adolescence is linked to an increased risk of suicide attempts in early adulthood [32].
Of the participants, 21 (35.0%) rated their academic performance as good or very good, while 39 (65.0%) rated it as average or poor. Previous research has linked low academic achievement in childhood and adolescence with an increased risk of suicidal ideation in adulthood [33,34]. A national study examining adolescent suicide risk factors similarly identified poor academic performance as a predictor of both suicidal thoughts and attempts [35]. Low grades can undermine self-esteem and invite negative criticism or blame from family members, potentially fostering depressive symptoms and suicidal ideation. Moreover, excessively high parental academic expectations have been shown to elevate stress and depressive symptoms among adolescents [36,37].
Of the 60 adolescents assessed, 40 (66.7%) met DSM-IV criteria for at least one psychiatric disorder, while 20 (33.3%) did not. Major depressive disorder (MDD) was the most prevalent diagnosis, affecting 25 participants (41.7%), followed by anxiety disorders (AD). Both MDD and AD are well-established risk factors for suicidal ideation and attempts. Large-scale studies have confirmed that depressive and anxiety symptoms significantly correlate with suicidal thoughts and behaviors in adolescents [38,39]. Moreover, these disorders disproportionately affect girls, who are nearly twice as likely as boys to receive diagnoses of MDD or AD [40]—a pattern reflected in our predominantly female sample.
In the present study, 19 of the participants (31.7%) came from divorced families. Parental divorce is a distressing process that exposes both children and parents to feelings of dissatisfaction, sadness, and anger, and adolescents are particularly vulnerable to its effects. In recent years, divorce rates have risen across Europe and the United States [41-43]. Post-divorce changes—in home environment, schooling, social circles, and family income—can overwhelm adolescents’ coping capacities and contribute to psychiatric disorders such as major depression and anxiety [44,45]. When we examined parental education, 38 mothers (65.4%) and 28 fathers (46.5%) had only primary-school education or less; tertiary-level education was relatively rare (15.3% of mothers, 13.8% of fathers). Studies have linked low parental education to an elevated suicide risk in children [46], and a meta-analysis confirmed that children of parents with ≤12 years of schooling face higher rates of suicidal behavior [47]. Regarding methods of attempt, medication ingestion was most common (60.0%), followed by sharp-object injury (21.7%), then jumping from height, hanging, and throwing oneself in front of a vehicle. This predominance of self-poisoning mirrors findings from other Turkish studies: one from 2014 reported 83.6% of adolescent attempters used medication [4],8 Doğan et al. [35] found a 96% rate, and Özsoylu et al. [49] observed 100%. The widespread availability of medications in households—and often without prescription—likely explains this pattern. Our results align closely with these previous reports.
Among the factors precipitating suicide attempts in our cohort, family-related stressors—particularly family conflict—were most prominent: 34 participants (56.7%) cited it as the trigger. Peer bullying/conflict (18.3%) and academic stress (16.7%) were the next most frequent precipitants. The literature consistently shows that adolescents who attempt suicide often experience significant life stressors beforehand—family discord, romantic-relationship problems, financial hardship, academic failure, and physical or sexual abuse are among the most commonly reported [50,51]. Several studies have also linked school-related stress and academic pressure with suicidal ideation and attempts [52]. Adolescents frequently equate their self-worth with academic success; thus, those with low grade point averages or who view themselves as underachievers often suffer reduced self-esteem, which may contribute to suicidal behavior [53].
It was found that 40.0% of the adolescents in our study had a history of previous suicide attempts, and 33.3% had a family history of suicide. While no single risk factor can definitively predict a suicide attempt in an adolescent, several high-evidence etiological factors have been identified. These include a family history of suicide, a previous suicide attempt by the individual, adoption, gender dysphoria, male sex, and the presence of psychopathology in the parents [54]. A history of nonsuicidal SHB is also a significant indicator of potential suicide attempts [55]. Non-suicidal SHB is frequently observed in adolescents who attempt suicide. In our study, 42 adolescents (70.0%) reported a history of non-suicidal SHB. The findings of our study are consistent with the literature.
The present study examined the relationship between SHB and previous suicide attempts in relation to the individual and familial characteristics of the participants. Chi-square and Fisher’s exact tests revealed the following results: there is a significant relationship between low academic performance and SHB, with low academic performance increasing the risk of SHB. Furthermore, participants with both parents living together had a significantly higher history of previous suicide attempts compared to those with divorced parents. This finding is particularly interesting and warrants further investigation. Although the avoidance of conflicts between parents in divorced families might appear beneficial, it is well documented that parental separation can lead to numerous negative outcomes in adolescent development. Therefore, this finding should be explored in more depth.
These findings carry several important implications for clinical practice. First, the high rates of non-suicidal self-injury and prior psychiatric diagnoses among adolescents who attempt suicide underscore the need for routine mental health screening in pediatric emergency departments. Implementing brief, structured assessment tools to detect depressive symptoms and SHB may help identify high-risk individuals before a suicide attempt occurs. Second, given that most attempts occurred at home and were triggered by family conflict, clinicians should be trained to assess family dynamics and psychosocial stressors during initial evaluations. Family-based interventions and psychoeducation targeting communication and conflict resolution may reduce recurrent crises. Third, the strong association between poor academic performance and self-harm highlights the role of schools in suicide prevention. Mental health professionals should collaborate with school counselors to provide targeted support for struggling students. Finally, the notable proportion of participants with a parental history of psychiatric illness suggests that family mental health assessments and referrals may be essential components of a comprehensive care plan. Early identification and timely intervention—especially for adolescents presenting with prior self-harm, low academic achievement, or family dysfunction—can significantly reduce the risk of recurrent suicidal behavior.
Limitations and future research
This study has several limitations. Its single-center design and modest sample size limit the generalizability of our findings. Nevertheless, the prospective design and the collection of data via interviews with participants and their families in the days immediately following the suicide attempts enhance the reliability of our measures. Our results indicate that suicide attempts peak during middle adolescence, and that being female is associated with increased risk. A notable proportion of attempters had mothers with significant psychiatric disorders, and parental higher-education levels were generally low. Most attempts occurred at home and were precipitated by family disputes; medication ingestion was the predominant method. Furthermore, a majority of adolescents who attempted suicide had a history of non-suicidal SHB, and most met criteria for at least one psychiatric disorder. To validate and extend these findings, future research should employ larger, multicenter samples and standardized assessment methods.
Conclusions
This prospective single-center study of 60 adolescents who attempted suicide revealed that middle adolescence represents a critical period of elevated risk, particularly among females. Two-thirds of participants met criteria for at least one psychiatric disorder—most commonly MDD—and 70% reported prior non-suicidal self-harm. Family conflict emerged as the leading precipitant, and medication ingestion was the predominant method. Parental divorce and low academic performance were significantly associated with self-harm, underscoring the influence of both familial and individual factors. These findings highlight the urgent need for targeted screening and intervention strategies in pediatric emergency and outpatient settings. Early identification of at-risk youth—especially those with depressive symptoms, SHB history, and family dysfunction—may facilitate timely psychiatric referral and psychoeducational support. Future multicenter studies with larger samples and standardized measures are warranted to validate these results and inform preventive programs tailored to adolescents’ developmental needs.
Notes
Availability of Data and Material
The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.
Conflicts of Interest
The authors have no potential conflicts of interest to disclose.
Author Contributions
Conceptualization: Bari Ay, Ayşegül Ay. Data curation: Bari Ay, Umut Balatacı. Formal analysis: Bari Ay, Umut Balatacı. Investigation: Bari Ay, Umut Balatacı. Methodology: Bari Ay, Ayşegül Ay. Project administration: Umut Balatacı. Software: Bari Ay, Ayşegül Ay. Supervision: Umut Balatacı, Ayşegül Ay. Writing—original draft: all authors. Writing—review & editing: Umut Balatacı, Ayşegül Ay.
Funding Statement
None
Acknowledgments
None