Risk and Protective Factors,
and Warning Signs
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Suicide is an extremely complex interaction involving a number of
factors that all contribute to the expression of suicidal behaviors. There
are numerous risk factors for suicide, any one of which may be present
or absent in an adolescent at-risk for suicide. Researchers have
identified a number of factors associated with a higher risk for suicide.
Protective factors that may reduce the likelihood of suicidal behavior
have also been found.
Suicide does not lend itself easily to an identifiable period of symptoms
that occur before the disease…however, research does show that
roughly nine out of ten adolescents who die by suicide give clues to
others before their suicidal attempt (5). Being able to recognize these
clues and knowing the risk factors associated with adolescent suicide
may help school staff prevent a student at-risk for suicide from
attempting and/or completing suicide. The importance of risk and
protective factors can vary by age, gender, and ethnicity (13).
There is no tangible, all encompassing method for determining if an
adolescent will attempt or die by suicide. Many students will present
some of the factors mentioned in the checklist of risk factors that
follow…however, not all will feel, act, or have ideas about suicide.
By using this checklist, school administrators and staff may be able to
recognize a student at-risk for suicide and who may need help. By
recognizing a teen who is potentially at-risk for suicide, staff and
administration take the first, and the most important step for alleviating
and reducing the risk for suicide. Only after a student has been
identified as at risk can he or she get help and intervention, which is of
paramount importance for preventing a student from attempting or dying
by suicide.
The impact of some risk factors can be reduced by interventions such
as providing treatment for depression or substance abuse. Those risk
factors that cannot be changed (such as a previous suicide attempt) can
alert others to the heightened risk of suicide during periods of the
recurrence of a mental or substance abuse disorder, or following a
significant stressful life event (11).
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Prepared By:
Justin Doan
Stephen Roggenbaum
Katherine Lazear
Design & Page Layout: Bill Leader
© 2003, Louis de la Parte Florida Mental Health Institute
Suggested Citation: Doan, J., Roggenbaum, S., & Lazear, K. (2003). Youth suicide prevention
school-based guide—Issue brief 3a: Risk Factors: Risk and protective factors, and warning signs.
Tampa, FL: Department of Child and Family Studies, Division of State and Local Support, Louis de
la Parte Florida Mental Health Institute, University of South Florida. (FMHI Series Publication #218-3a)
This publication is also available on-line as an Adobe Acrobat PDF file:
http://www.fmhi.usf.edu/institute/pubs/bysubject.html or
http://cfs.fmhi.usf.edu/cfsinfo/hotpubs.cfm
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Research has shown that the following are risk
factors for suicide in adolescents: previous suicide
attempt or gesture (2,4,6,7,9,10); mood disorder or
psychopathology (2,4,7,8,9,10); substance abuse
disorder (2,4,7,8,9,10); family history of suicidal
behavior or mental illness (4,8,10); relationship,
social, work, or financial loss (3,4,8,10); access to
firearms (3,4,8,10); contagion or exposure to
individuals who have attempted or completed suicide
with exposure through media, television, and direct
contact (8,10,11); history of physical or sexual abuse
(6,7,10); conduct disorder (7,10); juvenile
delinquency (7,10); sexual orientation, which has
been shown to be correlated with identified risk
factor’s for suicide and is less of a factor after
controlling for these risk factors (2,4,8,10); stressful
life events (7,10); chronic physical illness (2,4,8);
impulsive or aggressive tendencies (3,4); living
alone/runaways (7,10); and school problems (2).
Measures that enhance resilience or
protective factors are as essential for
preventing suicide as reducing the factors
that increase risk for suicide.
Positive resistance to suicide is not permanent, so
programs that support and maintain protection
against suicide should be ongoing (11). The following
factors have shown to be protective for suicide:
parental/family support and connectedness
(2,4,7,11,12), good social/coping skills (11,12),
religious/cultural beliefs (2,4,11,12), good
relationships with other school youth/best friends
(7,12), lack of access to means (10,11), support from
relevant adults/teachers/professionals (7,11,12),
help-seeking behavior/advice seeking (12), impulse
control (7), adaptive problem solving/conflict
resolution abilities (11), social integration/
opportunities to participate (7,12), positive sense of
worth/confidence (7,12), stable environment (7),
access to and care for mental/physical/substance
disorders (11), responsibility for others/pets (7), and
perceived connectedness to school (2).
The following checklist presents risk and protective
factors that have been found to be associated with
adolescent suicide. This checklist is intended for use
by school staff in order to help identify a student who
may be at-risk for suicidal behavior.
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Warning Signs

Also included is a list of warning signs, which may
indicate that the adolescent is thinking about suicide.
Again, it must be noted that these factors and
warning signs do not provide a definitive method for
determining if a student is or is not suicidal, but
rather presents a method to help identify potentially
suicidal adolescents.
In 1997 the American Academy of Child &
Adolescent Psychiatry adopted a list of symptoms
and warning signs for adolescents who may try to kill
themselves. The list was updated in November 1998.
Suicide Awareness Voices of Education (SAVE) has
also compiled a list of teen symptoms of depression
and warning signs of suicide.
Three state suicide prevention program guideline
manuals were consulted and used to update the
following list of warning signs: Maine Youth Suicide
Prevention Program, Washington State’s Youth
Suicide Prevention Program (YSPP), and the Virginia
Guidelines for Suicide Prevention manual. Items from
all three lists are combined and appear in this
section.
Evidence has shown that approximately nine out of
ten adolescents at-risk for suicide will give definite
signals that they feel suicidal. The key to prevent
suicide is to know these warning signs and know
what to do when faced with a student who presents
these signs so that they may get the help they need.
Many of the symptoms of suicidal feelings are similar
to those of depression. Parents and educators should
be aware of the following signs adolescents who feel
suicidal may express. Many of these signs are similar
to the signs for depression. Usually these signs will
persist for more than two weeks or more in
adolescents potentially at-risk for suicide…however,
some youths behave impulsively and act out suicidal
behaviors or express suicidal thoughts quickly.
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EARLY WARNING SIGNS

Early Warning Signs
• Withdrawal from friends and family
• Preoccupation with death
• Marked personality change and serious mood
changes
• Difficulty concentrating
• Difficulties in school (decline in quality of
work)
• Change in eating and sleeping habits
• Loss of interest in pleasurable activities
• Frequent complaints about physical
symptoms, often related to emotions, such
as stomachaches, headaches, fatigue, etc.
• Persistent boredom
• Loss of interest in things one cares about
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LATE WARNING SIGNS

• Actually talking about suicide or a plan
• Exhibiting impulsivity such as violent actions,
rebellious behavior, or running away
• Refusing help, feeling “beyond help”
• Complaining of being a bad person or feeling
“rotten inside”
• Making statements about hopelessness,
helplessness, or worthlessness.
• Not tolerating praise or rewards
• Giving verbal hints with statements such as:
“I won’t be a problem for you much longer,”
“Nothing matters,” “It’s no use,” and “I won’t
see you again”
• Becoming suddenly cheerful after a period
of depression-this may mean that the student
has already made the decision to escape all
problems by ending his/her life
• Giving away favorite possessions
• Making a last will and testament
• Saying other things like: “I’m going to kill
myself,” “I wish I were dead,” “or “I shouldn’t
have been born.”
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References
Risk Factors: Risk and Protective Factors, and Warning Signs
1. Borowsky, I., Resnick, M., Ireland, M., Blum, R. (1999). Suicide attempts among American Indian
and Alaska native youth. Archives of Pediatrics and Adolescent Medicine, 153, 573–580.
2. Borowsky, I.W., Ireland, M., Resnick, M.D. (2001) Adolescent suicide attempts: Risks and
protectors. Pediatrics, 107(3), 485–493.
3. Brent, D., Johnson, B., Perper, J. (1994) Personality Disorder, personality traits, impulsive
violence, and completed suicide in adolescents. Journal of the American Academy of Child and
Adolescent Psychiatry, 33, 1080-1086.
4. Gould, M., Greenberg, T., Velting, D., Shaffer, D. (2003). Youth Suicide Risk and Preventive
Interventions: A Review of the Past 10 Years. Journal of the American Academy of Child and
Adolescent Psychiatry, 42(4).
5. Hicks, B.B. (1990). Youth suicide: A comprehensive manual for prevention and intervention.
Bloomington, IN: National Education Service.
6. Kaplan, S., Pelcovitz, D., Salzinger, S., Mandel, F., Weiner, M. Adolescent physical abuse and
suicide attempts. Journal of the American Academy of Child and Adolescent Psychiatry, June
1997 v36 n6 p799(10).
7. Maine Youth Suicide Prevention Implementation Plan, (1998).
8. Moscicki, E. (1999). Epidemiology of Suicide. In DG Jacobs (ed), The Harvard Medical School
Guide to Suicide Assessment and Intervention. San Francisco: Jossey-Bass Publishing 1999:
40–51.
9. Shaffer D., Gould, M., Fisher, P. (1996). Psychiatric diagnosis in child and adolescent suicide.
Archives of General Psychiatry, 53, 339–348.
10. Shaffer, D., Pfeffer, C.R., Work Group on Quality Issues. (2001).
Practice Parameter for the Assessment and Treatment of
Children and Adolescents With Suicidal Behavior. Journal of the
American Academy of Child and Adolescent Psychiatry, 40(1)
supp, 24–51.
11. U.S. Public Health Service. (1999). The Surgeon General’s Call
to Action to Prevent Suicide. Washington, DC.
12. World Health Organization. (2000). Preventing Suicide: A
Resource for Teacher’s and Other School Staff. Mental and
Behavioral Disorders, Department of Mental Health, Geneva.
13. National Youth Violence Prevention Resource Center.
Data retrieved March, 2003, from
http://www.safeyouth.org/topics/suicide.htm