{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T11:02:45Z","timestamp":1785150165577,"version":"3.55.0"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Childhood suicide attempts requiring pediatric intensive care unit (PICU) admission represent some of the most severe forms of self-harm and are associated with substantial morbidity and mortality. This study aimed to identify potential psychosocial factors and clinical warning signs preceding severe suicide attempts in children and adolescents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective study was conducted in the PICU of Van Regional Training and Research Hospital between January 2017 and January 2025. Children aged 8\u201318 years admitted following intentional self-harm or suicide attempts were eligible. Survivors participated in structured face-to-face interviews. For deceased patients, information was obtained from at least three first-degree relatives and corroborated using medical records and reports from treating physicians.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During the study period, 256 individual patients accounted for 289 suicide-related PICU admissions, of whom 116 met the inclusion criteria. The cohort included 81 females (69.8%) and 35 males (30.2%), with a mean age of 15.5 \u00b1 2.1 years. Patients were classified according to the presence of documented healthcare encounters within the preceding year: Group 1 (80\/116, 69.0%) had at least one prior healthcare contact for potential warning signs, whereas Group 2 (36\/116, 31.0%) had none. Group 2 patients were younger, more frequently aged 8\u201313 years, and experienced significantly higher morbidity and mortality. Mortality was significantly higher among boys aged 8\u201313 years. The highest mortality rates were observed among patients with gender identity-related distress (3\/3) and pregnant adolescents reporting violations of sexual consent (3\/4), although these findings were based on very small subgroups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Nearly 70% of children who attempted suicide had prior healthcare encounters for potentially recognizable warning signs, including psychosomatic complaints, humiliation or bullying, exposure to violence, and gynecological presentations. These findings highlight opportunities for earlier recognition of psychosocial distress during routine clinical encounters. Given the retrospective single-center design and absence of a non-suicidal comparison group, the results should be considered exploratory and hypothesis-generating rather than predictive.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2026.1881780","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T10:52:43Z","timestamp":1785149563000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical warning signs preceding severe suicide attempts requiring pediatric intensive care in children and adolescents"],"prefix":"10.3389","volume":"17","author":[{"given":"Merve","family":"Boyraz","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Van Research and Training Hospital, Health Sciences University","place":["Van, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Servet","family":"Y\u00fcce","sequence":"additional","affiliation":[{"name":"Department of Public Health, \u0130stanbul Provincial Health Directorate","place":["\u0130stanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00fcls\u00fcm Feyza","family":"K\u0131z\u0131ltan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Private Lokman Hekim Hayat Hospital","place":["Van, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hazal Ceren","family":"Turgut","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Critical Care, Van Research and Training Hospital, Health Sciences University","place":["Van, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osman Faruk","family":"Bayramlar","sequence":"additional","affiliation":[{"name":"Haver Pharma","place":["Istanbul, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edin","family":"Botan","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Pediatric Critical Care, Van Research and Training Hospital, Health Sciences University","place":["Van, T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e2023064800","DOI":"10.1542\/peds.2023-064800","article-title":"Suicide and suicide risk in adolescents","volume":"153","author":"Hua","year":"2024","journal-title":"Pediatrics"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3390\/children8020059","article-title":"Understanding suicide in our community through the lens of the pediatric icu: An epidemiological review (2011\u20132017) of one midwestern city in the us","volume":"8","author":"Kampfschulte","year":"2021","journal-title":"Children"},{"key":"B3","unstructured":"Mental Health Information\n          \n          2025"},{"key":"B4","doi-asserted-by":"publisher","first-page":"558","DOI":"10.3390\/children10030558","article-title":"Suicidality prevalence in a pediatric psychiatric clinic: Relation to social and environmental risk factors","volume":"10","author":"Ilia","year":"2023","journal-title":"Children"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1097\/pcc.0000000000003148","article-title":"Adolescent drug ingestions requiring icu stay: Single-center retrospective cohort study","volume":"24","author":"Titus","year":"2023","journal-title":"Pediatr Crit Care Med"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1111\/appy.12452","article-title":"Suicide prevention in childhood and adolescence: A narrative review of current knowledge on risk and protective factors and effectiveness of interventions","volume":"13","author":"Wasserman","year":"2021","journal-title":"Asia\u2010Pac Psychiatry"},{"key":"B7","doi-asserted-by":"publisher","first-page":"8604","DOI":"10.3390\/ijerph19148604","article-title":"Analysis of attempted suicide in a pediatric setting: Extracted notes for clinical practice and complexity of help","volume":"19","author":"Lesinskien\u0117","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"B8","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.sste.2016.03.002","article-title":"Model-based testing for space\u2013time interaction using point processes: An application to psychiatric hospital admissions in an urban area","volume":"17","author":"Meyer","year":"2016","journal-title":"Spatial Spatio-temporal Epidemiol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1016\/j.eclinm.2018.10.004","article-title":"What works in youth suicide prevention? 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