Background: In several countries, suicide is one of the leading causes of mortality and morbidity among adolescents, making it a major public health problem. Suicide can be prevented with accurate and prompt evaluation of mental illness and successful care, as well as informed media reporting of suicide and environmental monitoring of risk factors. Objective: This study was designed to assess the predictive value of the Poisoning Severity Score ((PSS) IPCS/EAPCCT)) in the outcome of suicide by pesticides in adolescents and provide data on risk/precipitating factors. Methods: Observational prospective surveys were conducted on 100 adolescent patients presented with acute suicidal pesticides poisoning within a six-month period and met the inclusion criteria. Results: Most of the patients (96. 0%) reported adverse life events and recent stressors, 77. 0% of the patients were diagnosed with anxiety, 52. 0% were diagnosed with depression, and 29. 0% were diagnosed with personality disorders. Significant higher total PSS was found in patients who died (2. 22 ± 0. 24) compared to those admitted to ICU (1. 47 ± 0. 23); p=0. 001 and the total PSS for the patients admitted to ICU(1. 47 ± 0. 23) was significantly higher than those admitted to Alexandria Poison Center (0. 64 ± 0. 26) p<0. 001. Analysis of the ROC curve for the total poisoning severity score (PSS) as a predictor of mortality revealed that the area under the curve (AUC) was 0. 991 with high sensitivity (94. 74%) and specificity (98. 77%) for PSS >2 and P-value was highly significant (p<0. 001). Conclusion: Aluminum phosphide, organophosphorus, and zinc phosphide are the most used pesticides for committing suicide in adolescence by this order in Alexandria. In the present study, the presence of major life events, recent stressors, diagnosis with depression, and diagnosis of anxiety were associated with the suicide event. Finally, Poisoning Severity Score can be used as a predictor to provide the families with the possible outcome/prognosis for their patients and to have the medical team prepared for specific medical attention needed by the patients, especially in PSS 3 and 4.