Public high school students in Hawai'i attempted suicide last year nearly twice as often as the national average, according to a new study.

The report released this week by the state Department of Health also said that more than 18 percent of Hawai'i students have "seriously considered" suicide, the second-highest rate in the nation.

When all age groups are included, there are about 120 suicides annually in Hawai'i, one every three days, the study said.

"It shows that suicides are still the leading cause of death by fatal injury in the state" — exceeding auto accidents, said Dan Galanis, state epidemiologist and co-author of the study, which covers 2001-07.

"The fact that there have been no big changes in the number of suicides is noteworthy in itself," Galanis said.

The study said that most teens who attempt suicide do so because of romantic, family or school problems; adults ages 40 to 64 are most likely to try because of financial or legal problems; and senior citizens because of health issues.

The common denominator in nearly all suicides is loss, said Chris Piper, who has helped train more than 600 teachers, mental-health professionals and parents on how to recognize and deal with suicidal tendencies.

"When stressers are higher, you need to be more alert for thoughts of suicide," Piper said. "Whether it's military-related or has to do with finances or anything, loss is a big deal. It could be loss of self esteem, a buddy, a job, a girlfriend, a marriage."

A suicide attempt is often a cry for help, she said, so the key to preventing suicide is directly asking a person who has suffered a loss.

"Simply asking someone 'Are you thinking of suicide?' is far more helpful than teaching a laundry list of what to look for. If someone says yes and you don't know what to do next, get them to someone who can help. The gatekeepers we train are taught how to help them."

Galanis said the Hawai'i study might actually underreport the number of suicides because unattended deaths can't always be categorized. Information for the study was gleaned from autopsy and hospital reports.

The state study also showed that:

• 12 percent of public high school students in Hawai'i attempted suicide last year, compared with 6.9 percent of high school students nationwide.

• The youngest victim was 10, but 95 percent were 19 or older.

• Nearly 75 percent of those who attempt suicide have documented histories of mental problems.

• Males commit suicide three times more often than females.

• The ethnicity with the highest suicide rate is Caucasian.

• There were 44 suicides among people ages 10 to 18 from 2000 to 2007, making it the second-leading cause of death for that age group behind car crashes. For every child who dies from suicide in Hawai'i, an estimated nine are hospitalized and another 18 are treated at emergency departments after attempting suicide.

• 41 percent of all suicide victims had mentioned wanting to commit suicide.

Some experts who deal with suicides say it could get worse before it gets better because of layoffs, foreclosures and veterans returning from war.

"Right now, there's a lot of speculation that with the recent economic meltdown we'll see the suicides go up, but our databases aren't responsive enough to pick up that trend quickly," Galanis said.

Another recent report, the 2007 Youth Risk Behavior Surveillance System, based on a survey conducted in 39 states, showed that among Hawai'i's public high school students:

• Nearly 20 percent have "seriously considered" attempting suicide, second only to New Mexico's rate.

• 17 percent said they had made suicide plans (second to Wyoming).

• 12 percent reported they had attempted suicide, the third-highest rate behind New Mexico and North Carolina.