TABLE 126.12 CHARACTERISTICS ASSOCIATED WITH CHILDHOOD AND ADOLESCENT SUICIDE ATTEMPTS Positive family history Hopelessness Low self-esteem Active desire to die Depression Anger/desire for revenge TABLE 126.13 ASSESSING CHILDHOOD/ADOLESCENT SUICIDE ATTEMPTS: FOUR MAJOR DIMENSIONS Medical lethality Suicidal intent Impulsivity Strengths/supports The psychiatric evaluation should include an assessment of the actual and believed medical lethality of the act, the suicidal intent, the impulsivity of the act, and the strengths and supports within the family ( Table 126.13 ) The lethality of a suicide attempt by itself may be misleading because suicidal children may over- or underestimate the harm intended In general, more violent methods of attempted suicide (e.g., hanging, shooting, jumping) often reflect greater suicidal intent ( Table 126.14 ) However, the physician cannot conclude that attempts with low lethality are not serious attempts until they have specifically asked about and assessed the child’s suicidal intent, that is, determined how seriously the child wanted to end their life ( Table 126.15 ) These questions should be asked of the child without the parents in the room The physician should gather as much information as possible about the attempt itself to help infer the degree of suicidal intent on the part of the