Suicidal behavior—which encompasses both suicide attempts and completed suicides—is not classified as a medical illness, yet it represents a critical public-health concern. Over the past decade, it has emerged as a clinical condition demanding urgent attention from international health communities [1]. Each death by suicide constitutes a personal tragedy and profoundly affects the bereaved family and social networks [2]. As our understanding of suicide risk factors has evolved, a “suicide spectrum” framework has been proposed to differentiate: suicidal ideation (active/planned vs. passive/unplanned); suicide attempts, defined as self-harm with or without intent to die that does not result in death; suicidal behavior, which may or may not be fatal; suicide itself, the act resulting in death [3].

In the United States, suicide is the second leading cause of death among 10-19-year-olds [4], and rates have risen steadily in recent years. A survey of US high-school students found that 5.1% of males and 9.3% of females attempted suicide in the previous year [5]. Although the etiology of adolescent suicide is complex, rates of both suicidal ideation and attempts increase markedly during adolescence [6], with many individuals transitioning from thoughts to actions within 1 to 2 years of first ideation [7]. Contributing factors include improved capacity for suicide planning, underdeveloped emotional-regulation and problem-solving skills, and higher rates of mood and substance-use disorders [8]. The coronavirus disease-2019 pandemic has further exacerbated this trend globally through indirect stressors—separation, bereavement, disrupted schooling, and reduced social support [9-12]—and recent data reveal spikes in attempts and deaths across regions such as the US, UK, and South Asia [13,14].

While adolescent suicide is a global concern, epidemiological patterns and sociocultural risk factors vary significantly by country. In Türkiye, national data remain limited: a recent analysis of suicide deaths from 2004 to 2023 found that hanging and firearms were the most frequent methods, with family discord emerging as the leading precipitating factor among females [15]. Further, retrospective data from a Turkish province indicated that females predominate in adolescent suicide, with self-poisoning being more common among girls and hanging and firearms more frequent among boys. Additionally, emergency department-based comparisons between Turkish and US adolescents showed that 78% of Turkish suicide attempters were female, and medication ingestion was the primary method [16]. Therefore, our study addresses a critical gap in Türkiye-specific research on adolescent suicide attempts, contextualizing the demographic and clinical profiles within unique national trends.

This study aims to characterize the sociodemographic profiles of adolescents following a suicide attempt, describe the nature of their attempts, and determine the prevalence of psychiatric disorders in this population.

The mean age of the adolescents was 184.68±13.64 months (range: 144-211 months). Of the participants, 52 (86.7%) were female and 8 (13.3%) were male. The mean ages of their mothers and fathers were 42.28±6.27 years and 47.29±6.27 years, respectively. Sociodemographic characteristics of the participants are summarized in Table 1.

Of the participants, 52 (86.7%) lived in nuclear families and 8 (13.3%) in extended families; 41 (68.3%) had parents living together, while 19 (31.7%) came from divorced families. Detailed family characteristics are presented in Table 2.

The characteristics of the participants related to suicide attempts and suicide risk factors are shown in Table 3. The most frequently chosen method of suicide attempt was ingesting medication (60.0%). The most common trigger for the suicide attempt was family conflict (56.7%). Among those who attempted suicide, 70.0% had a history of SHB. Additionally, 50.0% of the participants had a history of psychiatric follow-up.

The relationship between SHB and previous suicide attempts with various variables is shown in Table 4. According to this, individuals with low academic performance had a significantly higher history of SHB compared to those with high academic performance (p=0.008). Among those whose parents lived together, there was a significantly higher history of previous suicide attempts compared to those with divorced parents (p=0.041).

This study examined the individual and familial profiles of adolescents after a suicide attempt, as well as the characteristics of their attempts. Participants ranged from 12.0 to 17.6 years of age (mean, 184.7±13.6 months). Females comprised 86.7% of the sample, and males 13.3%, indicating a markedly higher frequency of attempts among girls. Although adolescent girls report higher rates of suicidal ideation and attempts, boys exhibit higher suicide mortality—a phenomenon known as the “gender paradox” in suicidal behavior [21-23]. This disparity is largely attributed to the more lethal methods males tend to employ [24]. National data mirror these findings: one Turkish study found that 92.1% of youth who attempted suicide were female [25]. Internationally, attempt rates among adolescent girls are roughly double those of boys in China, India, and Nepal, and nearly triple in Bangladesh [26]. In the United States, high-school girls report higher rates of suicidal thoughts (19.3% vs. 12.5%), planning (15.0% vs. 10.8%), and attempts (9.8% vs. 5.8%) compared to boys.27 Our results reinforce these sex-based patterns in adolescent suicidal behavior.

The mean age of our participants was 15 years and 4 months. Middle and late adolescence are periods of heightened suicide risk. Proposed contributing factors include increased substance use, more frequent depressive symptoms, and sensation-seeking and risk-taking behaviors [28-30]. Inadequate coping skills and poor management of these challenges further elevate the likelihood of suicide attempts [31]. Additionally, suicidal ideation during middle and late adolescence is linked to an increased risk of suicide attempts in early adulthood [32].

Of the participants, 21 (35.0%) rated their academic performance as good or very good, while 39 (65.0%) rated it as average or poor. Previous research has linked low academic achievement in childhood and adolescence with an increased risk of suicidal ideation in adulthood [33,34]. A national study examining adolescent suicide risk factors similarly identified poor academic performance as a predictor of both suicidal thoughts and attempts [35]. Low grades can undermine self-esteem and invite negative criticism or blame from family members, potentially fostering depressive symptoms and suicidal ideation. Moreover, excessively high parental academic expectations have been shown to elevate stress and depressive symptoms among adolescents [36,37].

Of the 60 adolescents assessed, 40 (66.7%) met DSM-IV criteria for at least one psychiatric disorder, while 20 (33.3%) did not. Major depressive disorder (MDD) was the most prevalent diagnosis, affecting 25 participants (41.7%), followed by anxiety disorders (AD). Both MDD and AD are well-established risk factors for suicidal ideation and attempts. Large-scale studies have confirmed that depressive and anxiety symptoms significantly correlate with suicidal thoughts and behaviors in adolescents [38,39]. Moreover, these disorders disproportionately affect girls, who are nearly twice as likely as boys to receive diagnoses of MDD or AD [40]—a pattern reflected in our predominantly female sample.

In the present study, 19 of the participants (31.7%) came from divorced families. Parental divorce is a distressing process that exposes both children and parents to feelings of dissatisfaction, sadness, and anger, and adolescents are particularly vulnerable to its effects. In recent years, divorce rates have risen across Europe and the United States [41-43]. Post-divorce changes—in home environment, schooling, social circles, and family income—can overwhelm adolescents’ coping capacities and contribute to psychiatric disorders such as major depression and anxiety [44,45]. When we examined parental education, 38 mothers (65.4%) and 28 fathers (46.5%) had only primary-school education or less; tertiary-level education was relatively rare (15.3% of mothers, 13.8% of fathers). Studies have linked low parental education to an elevated suicide risk in children [46], and a meta-analysis confirmed that children of parents with ≤12 years of schooling face higher rates of suicidal behavior [47]. Regarding methods of attempt, medication ingestion was most common (60.0%), followed by sharp-object injury (21.7%), then jumping from height, hanging, and throwing oneself in front of a vehicle. This predominance of self-poisoning mirrors findings from other Turkish studies: one from 2014 reported 83.6% of adolescent attempters used medication [4],8 Doğan et al. [35] found a 96% rate, and Özsoylu et al. [49] observed 100%. The widespread availability of medications in households—and often without prescription—likely explains this pattern. Our results align closely with these previous reports.

Among the factors precipitating suicide attempts in our cohort, family-related stressors—particularly family conflict—were most prominent: 34 participants (56.7%) cited it as the trigger. Peer bullying/conflict (18.3%) and academic stress (16.7%) were the next most frequent precipitants. The literature consistently shows that adolescents who attempt suicide often experience significant life stressors beforehand—family discord, romantic-relationship problems, financial hardship, academic failure, and physical or sexual abuse are among the most commonly reported [50,51]. Several studies have also linked school-related stress and academic pressure with suicidal ideation and attempts [52]. Adolescents frequently equate their self-worth with academic success; thus, those with low grade point averages or who view themselves as underachievers often suffer reduced self-esteem, which may contribute to suicidal behavior [53].

It was found that 40.0% of the adolescents in our study had a history of previous suicide attempts, and 33.3% had a family history of suicide. While no single risk factor can definitively predict a suicide attempt in an adolescent, several high-evidence etiological factors have been identified. These include a family history of suicide, a previous suicide attempt by the individual, adoption, gender dysphoria, male sex, and the presence of psychopathology in the parents [54]. A history of nonsuicidal SHB is also a significant indicator of potential suicide attempts [55]. Non-suicidal SHB is frequently observed in adolescents who attempt suicide. In our study, 42 adolescents (70.0%) reported a history of non-suicidal SHB. The findings of our study are consistent with the literature.

The present study examined the relationship between SHB and previous suicide attempts in relation to the individual and familial characteristics of the participants. Chi-square and Fisher’s exact tests revealed the following results: there is a significant relationship between low academic performance and SHB, with low academic performance increasing the risk of SHB. Furthermore, participants with both parents living together had a significantly higher history of previous suicide attempts compared to those with divorced parents. This finding is particularly interesting and warrants further investigation. Although the avoidance of conflicts between parents in divorced families might appear beneficial, it is well documented that parental separation can lead to numerous negative outcomes in adolescent development. Therefore, this finding should be explored in more depth.

These findings carry several important implications for clinical practice. First, the high rates of non-suicidal self-injury and prior psychiatric diagnoses among adolescents who attempt suicide underscore the need for routine mental health screening in pediatric emergency departments. Implementing brief, structured assessment tools to detect depressive symptoms and SHB may help identify high-risk individuals before a suicide attempt occurs. Second, given that most attempts occurred at home and were triggered by family conflict, clinicians should be trained to assess family dynamics and psychosocial stressors during initial evaluations. Family-based interventions and psychoeducation targeting communication and conflict resolution may reduce recurrent crises. Third, the strong association between poor academic performance and self-harm highlights the role of schools in suicide prevention. Mental health professionals should collaborate with school counselors to provide targeted support for struggling students. Finally, the notable proportion of participants with a parental history of psychiatric illness suggests that family mental health assessments and referrals may be essential components of a comprehensive care plan. Early identification and timely intervention—especially for adolescents presenting with prior self-harm, low academic achievement, or family dysfunction—can significantly reduce the risk of recurrent suicidal behavior.