Sex disparities and increasing trends in pediatric suicidal behaviors: insights from a 10-year French pediatric emergency department study

Adolescent suicide is a major public health concern and the second leading cause of death among individuals aged 10-24. While suicide deaths are more common among males, suicide attempts and self-harm behaviors are significantly more frequent in adolescent females. Recent French national data report a sharp increase in hospitalizations for suicide attempts among females since 2015, particularly between ages 10 and 14. The reasons behind this widening sex gap remain unclear. We conducted a retrospective analysis of pediatric emergency department (PED) visits at Nice University Children's Hospital from 2013 to 2023. Cases of suicidal ideation (R45.8) and suicide attempts/self-harm (X60-X84) were identified using ICD-10 codes. Descriptive statistics were stratified by sex assigned at birth. A total of 3,263 PED visits related to suicidal behavior were recorded. Suicidal ideation visits increased by 290% over ten years, with females accounting for 80% of cases by 2023 (vs. 75% in 2013; p = 0.02). Suicide attempts remained stable in sex distribution (73% female in 2023), though females were significantly overrepresented in self-poisoning cases. Males were more likely to present with injuries involving sharp objects. Findings confirm an alarming rise in suicidal ideation among adolescent females. Sex-sensitive prevention and early intervention strategies are urgently needed. Broader environmental, hormonal, and psychosocial contributors warrant further investigation.