BackgroundChildhood suicide attempts requiring pediatric intensive care unit (PICU) admission represent some of the most severe forms of self-harm and are associated with substantial morbidity and mortality. This study aimed to identify potential psychosocial factors and clinical warning signs preceding severe suicide attempts in children and adolescents.MethodsThis retrospective study was conducted in the PICU of Van Regional Training and Research Hospital between January 2017 and January 2025. Children aged 8–18 years admitted following intentional self-harm or suicide attempts were eligible. Survivors participated in structured face-to-face interviews. For deceased patients, information was obtained from at least three first-degree relatives and corroborated using medical records and reports from treating physicians.ResultsDuring the study period, 256 individual patients accounted for 289 suicide-related PICU admissions, of whom 116 met the inclusion criteria. The cohort included 81 females (69.8%) and 35 males (30.2%), with a mean age of 15.5 ± 2.1 years. Patients were classified according to the presence of documented healthcare encounters within the preceding year: Group 1 (80/116, 69.0%) had at least one prior healthcare contact for potential warning signs, whereas Group 2 (36/116, 31.0%) had none. Group 2 patients were younger, more frequently aged 8–13 years, and experienced significantly higher morbidity and mortality. Mortality was significantly higher among boys aged 8–13 years. The highest mortality rates were observed among patients with gender identity-related distress (3/3) and pregnant adolescents reporting violations of sexual consent (3/4), although these findings were based on very small subgroups.ConclusionsNearly 70% of children who attempted suicide had prior healthcare encounters for potentially recognizable warning signs, including psychosomatic complaints, humiliation or bullying, exposure to violence, and gynecological presentations. These findings highlight opportunities for earlier recognition of psychosocial distress during routine clinical encounters. Given the retrospective single-center design and absence of a non-suicidal comparison group, the results should be considered exploratory and hypothesis-generating rather than predictive.
Radically different