Original ArticlesA 25-Year Review of Pediatric Suicides Distinguishing Features and Risk FactorsMolina, D. Kimberley MD∗; Farley, Norma J. MD†Author Information From the ∗Bexar County Medical Examiner's Office, San Antonio †Valley Forensics, Edinburg, TX. Manuscript received January 31, 2019; accepted March 1, 2019. The authors report no conflict of interest. Reprints: D. Kimberley Molina, MD, Bexar County Medical Examiner's Office, 7337 Louis Pasteur Dr, San Antonio, TX 78229. E-mail: [email protected]. The American Journal of Forensic Medicine and Pathology: September 2019 - Volume 40 - Issue 3 - p 220-226 doi: 10.1097/PAF.0000000000000485 Buy Metrics Abstract Childhood and adolescent suicides have been increasing worldwide in recent years, and the investigation of such deaths is often complex. Forensic pathologists frequently find themselves having to opine as to the manner of death in these difficult cases. The present study was undertaken to identify distinguishing features in childhood and adolescent suicides to assist in the investigation and prevention of these deaths. A 25-year review of pediatric suicides in a metropolitan area was performed, which showed a steady increase in pediatric suicides over time. Male pediatric suicides were more common than female, with both having an average age of 15 years. Gunshots wounds and hanging were the most common methodologies seen, with drug toxicity being more common in females and gunshot wounds more common in males. Approximately 20% of decedents had a psychiatric history, 25% had a previous history of a suicide attempt or ideation, and 24% had a history of drug use. Only a minority of decedents made their intentions known prior to the suicidal act (16%) or left a note of intent (16%). In 62% of cases, a temporal, precipitating event could be identified, of which conflict with a significant other (boyfriend or girlfriend) was the most common. No specific trends over time were identified. While these features may assist forensic pathologists in assessing a possible suicidal death in the pediatric age group, medicolegal death investigators must approach these deaths as they would any violent death in an attempt to accurately determine the manner of death regardless of the societal and familial implications of such a determination. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.