Suicide is the third leading cause of death in children ages 10 to 14 and the second leading cause of death in children ages 15 to 19 here in Canada. This week in the Archives of Pediatrics and Adolescent Medicine is a study taken from the data collected from the National Survey of Children's Exposure to Violence.

This study included a survey of a national sample of 1,186 young people between the ages of 10 through 17. In the month preceding the interview, 5.4 per cent of the total sample reported having suicidal ideation -- the intent to self-harm and kill oneself.

The study looked at different kinds of victimization including- peer victimization, sexual assault, maltreatment, witnessing family violence and exposure to community violence.

Peer-victimized youth -- those who had been bullied -- had almost 2.4 times greater the risk of suicidal ideation. Those youth who were sexually assaulted had about 3.4 times the risk and those who were maltreated had almost 4.4 times the risk of suicidal ideation. For those who were subject to poly victimization -- exposure to 7 or more individual types of victimization -- in the past year, their rate of suicidal ideation was almost 6 times more likely.

Understanding the impact to suicidal thoughts is important in understanding how to make changes. The results underscore the importance of understanding bullying and its link to teen suicide. Sexual assault is also traumatic, stigmatizing and associated with shame-producing qualities leading to its associated increase with teen suicide. Most importantly, adolescents who had experienced physical abuse, emotional maltreatment, neglect and custodial interference in the past year were at even higher risk of suicidal ideation. It is postulated that these events lead to hopelessness where there are negative expectations for the future. Adolescents victimized by caregivers leads to loss of safety, stability and nurturance.

For those with poly victimization -- it leads to rather than a single situation, a description of life condition. Victimization across categories leads to loss of resilience -- the bouncing back that we often expect or adolescents have.

Another interesting finding in the study was that there was a substantial association between suicidal ideation and living in a household with a stepparent or unmarried parent partner.

The overall findings highlight the need to include comprehensive screening in children with victimization for suicide. This study points to the importance of environment and the extreme importance of victimization prevention. Suicide prevention has to include addressing the safety of adolescents in their homes, their schools and their neighbourhoods.