Suicide in Children and Adolescents

Abstract

Suicide is second only to accidents as the most common cause of death for children and adolescents age 10 to 19 in Canada. All of the pediatric cases that were referred to the Hamilton Regional Forensic Pathology Unit from 1993 to 2002 were reviewed. For the purpose of this study, pediatric deaths were defined as deaths in the age group of 1 day up to and including 19 years of age. Specific criteria for suicide were applied to each case, independent of the manner of death issued by the coroner. The criteria were 3-fold. First, homicide had to be ruled out by the police investigation and autopsy findings. Second, the method had to be consistent with self-infliction. Finally, there had to be some evidence of suicidal intent. Questionable cases were discussed among the authors, and if reasonable intent could not be established, then the case was excluded. The autopsy and police reports were examined in detail regarding age, sex, location and method of suicide, presence of suicide notes, and any contributing psychologic factors or stressors. Of the 501 pediatric autopsies performed during the 10-year period, 31 (6%) met the criteria of suicide. The majority of cases (87%) were in older adolescents (age 15 to 19), and the male to female ratio was 2.4:1. Psychologic factors were identified in some of the cases, including depressed mood (77%), suicidal ideation (45%), previous suicide attempts (23%), and drug or alcohol problems (19%). Most of the suicides (61%) occurred in the victim's home, and 12 (39%) cases left a suicide note. In 9 cases (29%), alcohol or street drugs were detected postmortem, though in 8 cases toxicology was not performed. Hanging (48%) was the most common method of suicide, followed by firearms (13%), poisoning (10%), drowning (10%), and blunt force vehicular trauma (10%). Almost 60% of the male suicides were by hanging. No specific trend was identified in the 9 female suicides. These results were compared with similar studies within Canada and other countries. Overall, the method of suicide is dictated by what is convenient and readily available, though the acceptance of various suicide methods can change over time. Suicide prevention efforts should be tailored to address local trends.

Differences between children and adolescents who commit suicide and their peers: A psychological autopsy of suicide victims compared to accident victims and a community sample

“…Thus, in spite of depressive symptoms, general vulnerability and stressful conflicts, these children and adolescents were not easily recognized as suicidal by their caregivers. In our suicide group we found, like previous studies [6,20,21], an overrepresentation of boys. The most common method of suicide in this young age group was strangulation, followed by the use of firearms, also this in line with other studies [8,21,22].…”

“…In our suicide group we found, like previous studies [6,20,21], an overrepresentation of boys. The most common method of suicide in this young age group was strangulation, followed by the use of firearms, also this in line with other studies [8,21,22]. In the USA suffocation began occurring with increasingly frequency relative to firearms among 10-14-year-olds in the early 1990s [23].…”

Suicide or accident? A psychological autopsy study of suicide in youths under the age of 16 compared to deaths labeled as accidents

“…The overrepresentation of boys (71%) in the suicide group is in accordance with studies in other Western countries [3,19,20] but in contrast to Turkey [21], where 71% of suicide victims 15 years and younger were female. Likewise, Chinese suicide victims have a female-to-male ratio close to 1.0 [22].…”

“…Like Beautrais and Shaw [10,20], we found that a greater proportion of suicides (60%) took place in the family residence or in the garage used daily by the parents. This has also been found previously in adolescents under the age of 19 [25].…”

“…The time span between the child’s death and the interview period may also have increased the parents’ tendency not to report depression. International studies show that depression has a higher prevalence in older adolescents [20,27,29]. In his recent study, Gibbons [30] found that when clinical depression is present, the severity of the depression in youths is strongly related to suicide risk.…”