Changes from 1991 to 2009 point to an overall decrease in suicidal thoughts and behavior in US youth. The Youth Risk Behavior Survey data illustrate that suicidal ideation is very common among adolescents and that a significant percentage is carrying out serious suicide attempts. Fortunately, rates for completed suicide are comparatively low (US data for 2006: 4.16 per 100.000 among 1019 year olds; Cash & Bridge 2009). However, data indicate a progression in the development of acute suicidality from suicidal ideation, to planning and to a suicide attempt. Thus, suicidal thoughts always have to be considered a significant warning sign requiring professional advice. With respect to suicidal ideation and suicide attempts, there is a female preponderance in most countries (more than twice as common among females).