Internal and Emergency Medicine
https://doi.org/10.1007/s11739-020-02554-2
CE - LETTER TO THE EDITOR
Teen suicide: an underreported and emerging plague
Emiliano Gamberini1 · Etrusca Brogi1   · Domenico Pietro Santoanastaso1 · Emanuele Russo1 · Vanni Agnoletti1 ·
Costana Martino1
Received: 10 October 2020 / Accepted: 28 October 2020
© Società Italiana di Medicina Interna (SIMI) 2020
Keywords  Suicides · Adolescents · Bullying · Family relations · Prevention
Dear Editor,
In 2014, the World Health Organization (WHO) has pub-
lished ‘Preventing Suicide: A Global Imperative’ with the
aim to highlight and to sensitize the global public opinion
on suicide and suicide attempts and to support the develop-
ment of prevention strategies in our public health system [1].
Unfortunately, even if there is a lack of comprehensive
epidemiological data, suicide is an important cause of mor-
tality worldwide also in adolescences. According to the last
survey of the Italian National Institute of Statistics (ISTAT),
suicide is responsible for 6.3% of the cause of death among
children aged between 10 and 19 years in Italy [2]. Obvi-
ously, this phenomenon represents a major public health
concern. Not only suicide but also suicidality has to be
quickly identified and prevented. Suicidality covers suicidal
thoughts, suicide plans and suicide attempts, and it repre-
sents one of the most important risk factors for completed
suicide.
* Etrusca Brogi
etruscabrogi@gmail.com
Emiliano Gamberini
emiliano.gamberini@auslromagna.it
Domenico Pietro Santoanastaso
domenicopietro.santoanastaso@auslromagna.it
Emanuele Russo
emanuele.russo@auslromagna.it
Vanni Agnoletti
vanni.agnoletti@auslromagna.it
Costana Martino
costmartino74@gmail.com
1
Department of Anesthesia and Intensive Care, Bufalini
Hospital, Viale Giovanni Ghirotti, 286, 47521 Cesena FC,
Italy
Suicide risk factors are heterogeneous. Among all, we can
find female gender, family history of suicide, mental disor-
ders, substance and alcohol abuse, access to firearm, mood
disorders and stressful life events [3]. Nevertheless, the asso-
ciation between psychological, social and behavioral risk
factors is extremely complex. Other important risk factors
are represented by loss of family links and community sup-
port, impaired parent–child relationship, homeless, bullying,
difficulties in school, marginalization and racism. Not to be
underestimated, the social interaction had radically changed
in the last 15 years with a remarkable impact on mental well-
ness. Indeed, the reduction in direct social interactions and
the increased use of social network are associated with an
increased risk of mood disorders [4]. Parallelly, cyberbully-
ing represents a modern public health problem strictly con-
nected to suicidal ideation in adolescence, with a stronger
association compared with traditional bullying [5]. Bully-
ing can trigger and accelerate suicidality. In fact, victims of
cyberbullying are at risk of mental distress, depression and
suicidal ideation, and attempts.
In our Trauma Center Maurizio Bufalini Hospital
(Cesena, Italy), in the last 10 years, 11 cases of adolescence
attempted suicides were admitted, aged between 12 and
17 years. Remarkably, we observed an important increase
in the last 2 years: two cases in 2018 and three cases in
2019. Twenty-seven percentage of the cases were teenagers
of immigrant family and 30% have a psychiatric disease (i.e.,
major depressive disorder, obsessive–compulsive disorders).
The association between different traumatic life events and
attempted suicide was evident for the majority of the cases.
The most common reasons for suicide attempts were fam-
ily’s issue and problems at school. In 67% of the cases, sui-
cidal method was a fall from a window of a building. All
teen patients survived the event: only one remains with a
moderate motor disability.
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In conclusion, suicide and suicidality are important
public health problems, requiring consideration and inter-
vention. With this letter, we aim to draw attention to an
underestimated but tragic phenomenon that can arrive in
our emergency and intensive care department. Emergency
physicians and intensivists have to cope with this issue and
consequently be able to face new challenges. Teen clini-
cal management and parenthood communication are central
aspects and require specific medical and empathic skills.
Epidemiological data, prevention strategy and educational
programs have to be promoted in order to provide adequate
information not only to the parents but also at school or other
teens’ social environment for the sake of rapid identification
of potential risk factors.
Author contributions  The manuscript has been read, reviewed, and
approved by all of the Authors.
Funding  No funding.
Compliance with ethical standards  jurisdictional claims in published maps and institutional affiliations.
Conflict of interest  The Authors have no conflict of interest to declare.
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Internal and Emergency Medicine
Human and animals rights  All procedures were approved by our local
ethics committee.
Informed consent  All participants provided informed consent prior
to their participation.
References
1. World Health Organization preventing suicide: a global imperative
(2014) ISBN: 978 92 4 156477 9
2. Ferrara P, Ianniello F, Cutrona C, Quintarelli F, Vena F, Del Volgo
V et al (2014) A focus on recent cases of suicides among Italian
children and adolescents and a review of literature. Ital J Pediatr
40(1):69. https​://doi.org/10.1186/s1305​2-014-0069-3
3. Bilsen J (2018) Suicide and youth: risk factors. Front Psychiatry
9:540
4. Shakya HB, Christakis NA (2017) Association of facebook use
with compromised well-being: a longitudinal study. Am J Epide-
miol 185(3):203–211. https​://doi.org/10.1093/aje/kww18​9
5. van Geel M, Vedder P, Tanilon J (2014) Relationship between peer
victimization, cyberbullying, and suicide in children and adoles-
cents: a meta-analysis. JAMA Pediatr United States 168:435–442
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