A thorough medical literature review of adolescent self-reported suicide attempts focused on comparing the following: (1) the prevalence of attempts in anonymous vs. face-to-face surveys; (2) the prevalence rates in the United States and Canada vs. those reported elsewhere; and (3) the prevalence of attempt findings vs. self-harm behavior in anonymous surveys. The major findings were: (1) 29 anonymous self-report questionnaire studies from nine countries revealed that a median of 7–10% of adolescent students acknowledged having made one or more suicide attempts; (2) seven structured interview studies revealed a 3–4% lifetime prevalence of attempted suicide by adolescents; (3) self-report questionnaire responses failed to reveal any overlap between deliberate self-harm behavior and suicide attempts; (4) nonanonymous studies had an unusually high rate of refusal. Thus, self-reported suicide attempts are surprisingly frequent in adolescence and are reported two to three times more often under conditions of anonymity. Furthermore, youths report self-harm behavior as distinct from suicide attempts.