Silent Suicidal Ideation: Low Rates of Disclosure Among Children and Adolescents Who Attempt Suicide.

Suicide is the leading cause of death among individuals aged 10–19 years, and youth suicide in Japan is increasing. However, few studies have directly confirmed the actual situation of child and adolescent suicide attempters and their parents immediately after the attempts. We investigated whether children and adolescents disclosed suicidal ideation before their attempts through direct interviews with them and their families shortly after emergency department admission. This study was conducted in the Suicide Attempt Registry section of the “Registry Study of Child and Adolescent Mental Health in Japan” in collaboration with the National Kohnodai Medical Center, Japan Institute for Health Security. Patients aged < 18 years who attempted suicide were transported to the Tokai University Hospital Advanced Emergency Medical Center. Psychiatrists interviewed them and their families or guardians about the backgrounds of the attempts, focusing on whether the attempters had disclosed suicidal ideation to anyone. Overall, 76.0% (73.3% of females and 84.0% of males) of participants had not consulted anyone before their attempt. Additionally, 86.0% (84.0% of females and 92.0% of males) of all patients reported being unable to discuss their suicidal ideation with family members beforehand. While these tendencies were more common among males, no statistically significant gender differences were found. In conclusion, children and adolescents who attempted suicide usually faced challenges in disclosing their suicidal ideation to their close circle, particularly family members. This difficulty since childhood may be considered a psychosocial predisposing factor for suicide. To prevent repeated suicide attempts, it may be necessary to implement strategies that engage both youths and their families, particularly to address youths’ reluctance to openly discuss their problems with those close to them in clinical settings. Additionally, establishing a comprehensive, community‑based system that provides appropriate multidisciplinary support for individuals who have attempted suicide may be indispensable.