School-Associated Suicides—United States, 1994-1999 FREE

MMWR. 2004;53:476-478

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During 1994-1999, at least 126 students carried out a homicide or suicide that was associated with a private or public school in the United States.¹ Although previous research has described students who commit school-associated homicides, little is known about student victims of suicide. To describe the psychosocial and behavioral characteristics of school-associated suicide victims, CDC analyzed data from school and police officials. The results of that analysis indicated that, among the 126 students who carried out school-associated homicides or suicides, 28 (22%) died by suicide, including eight who intentionally injured someone else immediately before killing themselves. Two (7%) of the suicide victims were reported for fighting and four (14%) for disobedient behavior in the year preceding their deaths; none were associated with a gang. However, potential indicators of suicide risk such as expressions of suicidal thoughts, recent social stressors, and substance use were common among the victims. These findings underscore the need for school staff to learn to recognize and respond to chronic and situational risk factors for suicide.

Included in this analysis were suicides for which the victim was an elementary or secondary school student and the death occurred during July 1, 1994–June 30, 1999, in one of the following settings: (1) on the grounds of an operating public or private elementary or secondary school in the United States, (2) while the victim was en route to or from regular school sessions, or (3) while the victim was attending or traveling to or from an official school-sponsored event. Cases of school-associated suicide were identified through a systematic search of two computerized newspaper and broadcast media databases (i.e., Lexis-Nexis and Dialog). Data on the victims were collected through structured and standardized interviews with school and police officials and by reviewing police reports.

The 28 school-associated suicide victims included four students who first committed homicide and four other students who first inflicted nonfatal injuries on others. Among the suicide victims, 22 (78%) were males, 22 (78%) were non-Hispanic whites, and 17 (60%) lived with two parents (Table). Twenty-six (93%) of the suicide victims used firearms.

Eleven (39%) students were reported to be weekly users of alcohol or drugs, and five (18%) were reported intoxicated at the time of their suicides. Six (21%) of the students had a history of criminal charges; four (14%) had been reported for disobedience; two (7%) had been reported for fighting with peers; and no student was a known gang member. The majority (61%) of the students were involved in extracurricular activities. A total of 16 (57%) of the students had expressed suicidal thoughts, including 10 who confided in a peer. Eight (29%) students had experienced a romantic breakup and nine (32%) a household disruption such as moving or having a household member move out.

J Kaufman, PhD, Dept of Sociology, Univ of Miami, Florida. W Modzeleski, MS, Office of Safe and Drug Free Schools Program, U.S. Dept of Education. T Feucht, PhD, National Institute of Justice, U.S. Dept of Justice. TR Simon, PhD, M Anderson, MD, K Shaw, MPH, I Arias, PhD, Div of Violence Prevention, National Center for Injury Prevention and Control; L Barrios, DrPH, Div of Adolescent and School Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

The need for safe schools has prompted considerable interest in understanding and preventing all types of lethal school-associated violence. The finding that 22% of students who carried out such violence took their own lives indicates that a sizeable proportion of lethal school-associated violence was self-directed. In addition, the finding that approximately one in four suicide victims injured or killed someone else immediately before their suicide suggests an overlap between risk for committing school-associated homicide and risk for suicide. Efforts to prevent incidents of lethal school-associated violence should address youth suicidal ideation and behavior.

Suicide-prevention efforts are needed not only to address the risk for school-associated violence, but also to reduce the much larger problem of self-directed violence among adolescents overall. In 2001, suicide was the third leading cause of death in the United States among youths aged 13-18 years, accounting for 11% of deaths in this age group.² In 2003, approximately one in 12 high school students in the United States reported attempting suicide during the preceding 12 months.³ Data from Oregon indicate that approximately 5% of adolescents treated in hospitals for injuries from a suicide attempt made that attempt at school.⁴

The finding that the majority of students who were school-associated suicide victims were involved in extracurricular activities suggests that these students could be familiar to school staff who might recognize warning signs. Although these students were unlikely to stand out (e.g., by fighting or involvement in gangs) in the manner of those who commit school-associated homicides,¹ other established risk factors for suicidal behavior were common (e.g., expression of suicidal thoughts, recent household move, and romantic breakup). These findings support the need for school-based efforts to identify and assist students who describe suicidal thoughts or have difficulty coping with social stressors. School-based prevention efforts are likely to benefit from school officials working closely with community mental health professionals to enhance the abilities of school counselors, teachers, nurses, and administrators to recognize and respond to risk factors for suicide. CDC's School Health Guidelines recommend that school personnel be provided with regular staff development opportunities to prepare them to help prevent suicide.⁵ In 2000, only 15% of required health education courses were taught by teachers who received staff development on suicide prevention during the preceding 2 years, suggesting that additional opportunities for staff development are needed.⁶

The findings that one in four of the school-associated suicides were preceded by a recent romantic breakup and nearly one in five suicide victims were under the influence of drugs or alcohol at the time of their deaths underscore the potential importance of situational risk factors. Youth suicidal behavior often is an impulsive response to circumstances rather than a wish to die.⁷ Efforts to help students cope with stressors and avoid substance abuse are important elements of suicide-prevention strategies.⁸

The findings in this report are subject to at least four limitations. First, because events were identified from news media reports, any event not reported in the media was excluded; the nature of the events might have resulted in an undercount of the number of school-associated suicides. Second, certain estimates might be unstable because of the small cell sizes. Third, the data are from secondary sources and are subject to recall error or bias; the nature of these events might have influenced responses. Finally, the number of school-associated suicide victims reported with each characteristic might be undercounted, and the percentages of students with these characteristics might not be representative of all students who died by suicide during 1994-1999.

Prevention of youth suicide is a critical public health priority. The findings in this report underscore the need to "develop and implement safe and effective programs in educational settings for youth that address adolescent distress, crisis intervention and incorporate peer support for seeking help" as described in the Surgeon General's Call to Action to Prevent Suicide, 1999.⁸