Master's Project Title:

Suicide and Self-injury Among Children and Youth with Chronic Health Conditions

MCH Student:

Andrew J. Barnes, MD

Date of Defense:

June 15, 2009


Objectives: Determine the extent to which having a chronic physical and/or mental health condition in childhood contributes independently to risk of suicide and purposeful self-injury.

Methods:  Cross-sectional self-report data from the Minnesota Student Survey of 6th, 9th, and 12-grade youth (n=136,549).  Logistic regression was used to control for covariates, identify key explanatory variables, and estimate odds ratios for outcomes.  Main outcome measures:  Self-harm, suicidal ideation, and suicide attempts among youth with and without chronic health conditions (. 12 months’ duration), stratified by sex and grade level.

Results: Independent of race, socioeconomic status, family structure, special education status, substance use, and emotional distress, youth with both chronic physical and mental health conditions (n=4099) were at higher risk of self-harm (OR 2.54, 99%CI 2.28-2.82), suicide ideation (OR 2.54, 99%CI 2.27-2.84), and suicide attempts (Adjusted OR 3.48, 99%CI 3.07-3.94) than youth without such conditions (n=106,967).  Youth with either a chronic physical health condition (n=12,554) or a chronic mental health condition (n=8752) alone were at intermediate risk.  The findings were similar among males and females, and there was a risk gradient by grade level.

Conclusions:  Chronic physical and mental health conditions each confer independent risk for self-harm, suicidal thinking, and attempted suicide in 6th through 12th graders.  Youth with co-occurring mental and physical health conditions are at markedly elevated risk for these negative outcomes.  Preventative interventions that foster resiliency and socio-emotional well-being among these youth should be developed and evaluated.