Suicide After Contact With Child and Adolescent Mental Health Services—A National Registry Study

Abstract

BackgroundResearch has shown a strong association between suicide and mental disorders, and people in contact with services for mental health and substance use are known to be at high risk of suicide. Still, few studies have previously described suicide among young people in contact with Child and Adolescent Mental Health Services.AimThe aim of this study is to examine the prevalence of contact and suicide rates by gender and age groups, and to describe patient demographics and service utilization in secondary mental health services.MethodsAll young people in contact with Child and Adolescent Mental Health Services in the year prior to death in the period 2008–2018 were identified by linking the Norwegian Cause of Death Registry and the Norwegian Patient Registry. We estimated the prevalence of contact and suicide rates among those with and without contact, by gender and age groups. Characteristics of treatment contact were compared between boys and girls. Variables with significant differences were entered into a multivariate logistic regression model using gender as an outcome.ResultsMore girls (39.7%) than boys (11.8%) had contact with Child and Adolescent Mental Health Services in the year prior to death. Among girls, suicide rates per 100,000 patients increased linearly in the age groups 10–13, 14–16, and 17–19 years: 5, 22, and 38 per 100,000 patients, respectively. Among boys, the suicide rate increased sharply from 7 per 100,000 patients in the age group 14–16 years to 40 per 100,000 patients in the 17–19-year-old group. In the age-adjusted multivariate model, boys were 4.07 (1.22–14.44, p = 0.024) times more likely to have terminated contact at the time of death.ConclusionThis study shows gender differences in both suicide rates and service utilization among young people in contact with Child and Adolescent Mental Health Services before suicide, and future studies should focus on identifying the causes of these gender differences in service contact.

Adverse childhood experiences as risk factors for recurrent admissions in young psychiatric inpatients

“…Although the full sample of 390 inpatients was characterized by an almost even sex distribution (52% females), female patients represented the majority (78%) of young adult inpatients with a former CAP admission. This finding is in line with several previous papers showing a greater use of psychiatric services in women ( 1 , 26 ). While one Finnish cohort study of adolescent CAPs found a similar sex distribution (71% female) ( 7 ), the current results contradict observations from large cohort studies with around 1,000 participants of a balanced sex distribution ( 30 , 33 ) or a predominantly male population ( 8 ).…”

“…ACEs are associated with depressive symptoms only in adolescent girls, but not in boys ( 24 ), whereas with self-reported delinquency in boys, but not girls ( 25 ). When being distressed it is known that women in both adolescence ( 1 ) and adulthood ( 26 ) are more likely to contact inpatient services.…”

“…Patients who require psychiatric inpatient treatment (PIT) early in life seem to be a particularly vulnerable group with increased risks of suicide, chronic psychiatric disorders, comorbidity and ongoing service use (1)(2)(3)(4)(5)(6). Psychiatric inpatient treatment, in general, is regarded as an intensive intervention indicating a severe disability due to either a serious mental disorder or health-threatening psychosocial or trauma-related factors (7)(8)(9).…”