Objective: Anecdotally, we noticed an increasing number of adolescents evaluated in our psychiatric
emergency room after sending an electronic communication (text message, instant message, email, social networking site
posting) of suicidality. In this study we aimed to describe key similarities and differences among adolescents who
communicated their suicidality to others via electronic versus other means.
Methods: We reviewed consecutive adolescent psychiatric emergency room assessments over a 4-year time period
conducted at Children’s Hospital, Boston, a large tertiary care pediatric hospital, for the chief complaint of suicidality. We
broadly defined suicidality as ideation, intent, plans, attempts, and other self-injurious behaviors. We ascertained how the
patient communicated their suicidality, and to whom, and we obtained demographic and other pertinent clinical
Results: There were a total of 1,350 psychiatric evaluations done at Children’s Hospital, Boston for the chief complaint of
suicidality during the study period. The vast majority (n = 1260) of patients communicated their suicidality verbally or via
witnessed gesture. There were 54 who communicated suicidality via a hand-written note and 36 who communicated
suicidality via electronic means. Patients in our comparison groups were demographically and clinically similar. One
striking difference was to whom each group communicated their distress. Of those who communicated electronically, the
majority, 67%, did so to a peer and only 33% to an adult, whereas those who communicated via written notes were more
likely to do so to an adult. In the written note group, 7% communicated to a peer and 93% to an adult. Not surprisingly,
the numbers of electronic communications of suicidality increased over the four-year study period from 2005 to 2009.
Conclusions: The increasing use of technology for communication among adolescents may mean that a peer is the first
recipient of a ‘distress call’. Therefore, differential patterns of communication among adolescents with suicidality may
have implications for their clinical management and the timely provision of needed services. Our findings also point to the
importance of taking a media use history, particularly for adolescent patients who are high media users, and
psychoeducational prevention programs in schools concerning appropriate responses to such calls. Replication is needed
using prospective designs to conduct systematic inquiry about modes of communication used by suicidal adolescents.