Int. J. Environ. Res. Public Health 2012, 9 987 decades. One of the factors suggested to explain this trend is the growing use of antidepressants, especially selective serotonin reuptake inhibitors, in the adolescent population [3]. The prevalence of suicidal behaviors varies significantly across countries, cultures, and racial/ethnic groups worldwide [12]. Even within the same country, there are considerable differences among populations. In the United States, for example, adolescents of Indian/Alaskan descent have the highest rates of fatal suicidal behavior of all ethnic groups, and Latino and Caucasian youth have the highest rates of ideation and DSH [13]. Similarly, extremely high rates of suicide have been recorded for adolescents among the Inuit populations in Canada [14] and the Ethiopian population in Israel [15], which share a pattern of a failure of a traditional culture to integrate with modern Western culture. The large majority of suicides (90.5%) occur among Caucasian Americans. However, the rate for black adolescent males has been rising significantly and now approximates that of European Americans [12]. Interestingly, only about half of all black adolescent suicide attempters report ever having received a diagnosis of a mental disorder (by accepted criteria); this rate is much lower than rates reported in previous studies of adolescents in general [16]. This finding highlights the importance of moving beyond the study of mental disorders to a broader range of factors to improve our understanding of how suicidal behavior develops. Another recent epidemiological finding is the variation in the characteristics of youth suicide between Asian and Western countries. In rural China, southern India, Sri Lanka and Singapore, the gender differences for suicide are reversed from those in the West, with young women being at higher risk for suicide than young men; the mode of suicide attempts differs accordingly, consisting mostly of the impulsive use of pesticides [17]. Unlike Western suicidal youth, female attempters in China do not appear to have major mental illnesses [18]. These data have important theoretical and preventive implications. 4. Risk Factors for Suicidal Behavior Major established risk factors for suicide in youth include a previous suicide attempt, availability of lethal means, and family discord [19]. However, most of the studies focused on Caucasian youth, and less is known about the suicidal behavior of ethnic minorities. This section covers some of the important social risk factors underlying adolescent suicidal behavior. 4.1. Gender In Western countries, the rates of suicide across ethnicities are higher in adolescent boys than adolescent girls (ratio of 5:1), whereas the rates of suicidal ideation and attempted suicide are higher in girls (ratio of 3:1) [20]. Explanations for the higher suicide rate in boys include higher suicidal intent, use of more violent methods, higher prevalence of antisocial disorder and substance abuse, and greater vulnerability to stressors, such as legal difficulties, financial problems, and interpersonal loss [21]. Boys may also have more difficulties in asking for help and communicating their distress [22]. The gender gap in DSH is most pronounced among youths of Caucasian American descent and least pronounced among American Indians [23]. The gender gap in suicide mortality has been widening in recent decades, especially in some ethnic minority groups in the United States, mostly because of the