A 15-year-old white male was brought to the hospital emergency department after an intentional ingestion of about 20 tablets of acetaminophen in a suicide attempt. His mother had found him lying in his bed listening to loud music, an empty pill bottle on the floor next to him. Earlier the boy had come home from a baseball game visibly upset and reported that kids from the team had blamed him for losing the game. The patient lived with his parents and a younger sister. For more than a year, he had being struggling with school performance. He had been an A student throughout middle school but had not adjusted well to high school, academically or socially. His grades were now mainly C’s, and he had been failing some classes. Baseball was important to him, but he had difficulty concentrating, and his performance had deteriorated. He had seen a psychologist a few times during the past year because of his school difficulties and was found to be anxious. As a young child, he had severe separation anxiety. His anxiety symptoms had improved, but he continued to have excessive anxiety in social situations, and he tended to isolate himself from others. He was not sexually active, had not tried street drugs, and had not had any problems with the law. However, in the past year, he had used alcohol. In the past 2 months, he was less engaged with peers, easily upset, and irritated by minor stressors. He had shown bouts of anger but had never verbalized suicidal intentions. His relationship with his father, who was demanding and critical, was tense. A cousin to whom he was particularly close had recently died in a car accident. His mother had suffered from dysthymia and insomnia for years. As a young man, his father had social phobia and abused alcohol. A paternal uncle who had been dependent on alcohol died of liver failure. In the emergency department, the patient received gastric lavage. His acetaminophen plasma level was 106 mg/ml about 4 hours after the overdose. He was hospitalized in the medical ward and later was transferred to the psychiatric unit. He met diagnostic criteria for major depressive disorder of moderate to severe degree, as indicated by a total score of 62 on the Children’s Depression Rating Scale—Revised (1). He had clinically significant suicidal ideation, as indicated by a score of 37 on the Suicidal Ideation Questionnaire for youths (2). He had been depressed and functionally impaired for at least 1 year. He also met criteria for generalized anxiety disorder and social phobia. There was no history of mania. The patient reported that when he overdosed, he was upset and did not really think about the consequences of what he was doing, but he admitted that, at that moment, he wanted to die because he was tired of being a failure. He had not planned the act, and he took the acetaminophen from the medicine cabinet at home. He described his act as "silly" and said that he regretted having "lost control." Asked if he really believed he would have died of the overdose, he replied that he had not given any thought to it. What are some of the main risk factors for suicide in adolescents? What are the primary aims of treatment in suicidal youths? How would this patient best be treated?