Q. Are there specific factors that have been identified as contributing to these decreases?

A. One important factor appears to be improvements in the treatment of depression. This includes the increased use of SSRIs (serotonin selective reuptake inhibitors), drugs used to treat affective illnesses, among teens and young adults.

Q. There are gender differences in suicide attempt and completion rates among adults. Is this also true for adolescents and young adults?

A. Attempted suicide rates are higher among girls and completed suicide rates are higher among boys. As with older individuals, in teens and young adults these differences appear to result from the methods chosen. Girls and women are more likely to use drug overdose; boys and men are more likely to use firearms or hanging.

But firearms kill girls, too. If that is the method chosen, it is likely to result in a completed suicide in girls and boys.

Q. What are the most common risk factors for suicide and suicide attempts in adolescents and young adults?

A. Research on adolescents and young adults is producing converging evidence about factors that increase risk for suicidal behavior and suicide completion. Psychological autopsies are studies of individuals who have committed suicide; studies have produced information that is similar to the patterns emerging from epidemiological studies of young people who have attempted suicide. Taken together, these different types of studies indicate that major psychiatric disorder is an important risk factor for suicide and suicide attempts.

Mood disorders, for example, have been shown consistently to increase suicide risk. Substance abuse also has been identified as a risk factor, but substance abuse itself is more common among older boys, so patterns of risks associated with using drugs or alcohol may be different in different age and gender groups.

Q. What other types of risk factors have been identified?

A. A family history of suicidal behavior greatly increases the risk in teens and young adults. This may have a genetic component, which in turn may be related to serotonin problems.

Poor parent-child relationships are associated with increased risk. Other factors that increase risk for suicidal ideation and attempts include parental mental illness and substance abuse.

Other factors that appear to increase risk for suicide include a sense of hopelessness and the occurrence of stressful life events.

Q. Are there specific life stressors that increase suicide risk for teens?

A. It appears that two types of events may trigger suicidal behavior in some individuals: interpersonal losses (such as the break up of a relationship) and legal or disciplinary problems. It is important to emphasize, though, that it appears that it is the combination of stressful life events with an underlying vulnerability, such as a depressive illness, that results in increased risk.

Q.Is suicide risk higher for some adolescents and young adults?

A.Some studies have indicated that sexual orientation - self-identifying as gay or lesbian - increases the risk for suicidal behavior and thoughts, but not for completed suicide. Also, African Americans have historically had much lower rates of suicide than whites, but between 1986 and 1994, rates of completed suicide among African American males almost caught up to rates for white males in the 15-19 age group.

Q. What explains these differences?

A. It is unlikely that the difference between suicide rates in African American youth and white youth is attributable to stress - if that were true, one would expect that rates in African Americans would be far higher than in whites. So it's possible that some other type of factor is operating. But there have been far fewer studies on factors that protect teens and young adults from suicide than studies on increased risk. It has been suggested, though, that religiosity, in its social support aspect rather than its spiritual aspect, may help teens and young adults in some sub-groups.

Q.Are there other factors that influence teens and young adults?

A. Many studies indicate that suicide contagion and imitation are real. The studies show increases in rates of completed suicides and attempts after news accounts of suicide. Though the results are less consistent, some studies also show that fictional TV shows with suicide content also have an impact on rates of suicide and attempts.

These factors increase risk, but not to the same degree as psychiatric disorders do. Suicides in clusters account for about 1 percent to 5 percent of teen suicides in the United States, though rates vary by state and by year.