Adolescent suicide represents a major public health crisis with rates increasing over 50% in the past decade. Approximately 1 in every 10,000 youth will die by suicide, making suicide the second leading cause of death among adolescents. A robust body of research has assisted in the identification of several individual, parental, and environmental risk factors associated with adolescent suicide, including child maltreatment. However, the extent to which children and youth who died by suicide had a history of child maltreatment remains unknown. The present population-based, longitudinal study uses linked birth, death and CPS records to extend our understanding of the relationship between adolescent suicide and child protection system (CPS) involvement.

Findings from study 1, A Population-Based Examination of Suicide and Child Protection
System Involvement, indicated that among the children born in 2000 who died by suicide prior to age 18, nearly 57% had a prior CPS history. The suicide rate was 10.0 per 100,000 for those with no CPS history and 31 per 100,000 for children with a history of CPS contact. The children who had prior CPS contact had over 3 times the odds of dying by suicide compared to children with no such history. Interestingly, no discernable differences were detected between children with a substantiated allegation or foster care history when compared to children with an allegation only.

Findings from study 2, A Population-Based Case Control Study of Suicide Among Youth
Reported for Abuse and Neglect, showed that among all adolescents with a history of CPS involvement youth who had a past allegation of physical abuse or sexual abuse had higher odds of dying by suicide. Recency of contact with CPS also emerged as statistically significant factor distinctive to adolescents who died by suicide. Adolescents with a history of substantiated maltreatment allegations and adolescents who spent time in foster care were not significantly different from youth who were referred but never substantiated.

This project extends our understanding of adolescent suicide in two important ways. First, findings demonstrate that CPS contact was a common occurrence among youth who died by suicide. Findings also indicate that suicide risk is not concentrated among children and adolescents in foster care, but rather the much larger universe of children reported to CPS are at significantly heightened risk. Second, suicide risk appears to be more closely related to child maltreatment characteristics (maltreatment type, timing of abuse or neglect) than to system response (substantiation, foster care). This project reinforces the need for screening and prevention measures across the entire CPS spectrum, including children and families with an unsubstantiated allegation.