Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Suicide in children and adolescents

15.10.2012
Dr. Paramala J. Santosh, Maudsley Hospital, London, UK

Suicide in children and adolescents has long been a matter of great concern to modern society, particularly for clinicians who deal with mental health problems of children and adolescents.

For instance, in 1910 the Vienna Psychoanalytic Society with Sigmund Freud among the attending experts held a conference, dealing with what was perceived to be a growing epidemic of youth suicide (Greydanus & Calles, 2007).

At the beginning of the 21st century, suicide and suicide attempts by children and adolescents continue to be a major public health problem, and topical research and surveys have clearly highlighted suicide as one of the commonest causes of death among young people.

Epidemiology of suicide

Suicide is one of the major causes of death worldwide and suicide rates vary according to region, sex, age, time, ethnic origin, and, probably, practices of death registration. Most people who die by suicide have psychiatric disorders, notably mood, substance-related, anxiety, psychotic, and personality disorders, with high rates of comorbidity.

Suicidal cognitions and behaviours can occur both independently and together. Risk of onset of suicidal ideation increases rapidly during adolescence and young adulthood, and then stabilizes in early midlife. The prevalence rates in adolescents cross-nationally are reported to be 19.8.0% for suicide ideation, and 3.1%.8% for suicide attempts (Nock et al, 2008a). The incidence of suicide attempts reaches a peak during the mid-adolescent years, and at that age mortality from suicide, which increases steadily through the teen years, is the third leading cause of death.

Suicide in childhood and early adolescence is rare. However, in adolescents and young adulthood suicide rates increase to mean worldwide annual rates of suicide among 5 year olds of 0.5 per 100,000 for females and 0.9 per 100,000 for males, and for 15 year olds 12.0 per 100,000 for females and 14.2 per 100,000 for males, respectively (Pelkonen & Marttunen, 2003). Males often outnumber females in worldwide youth suicide statistics, although this is variable between different countries.

Suicide rates in elderly people have fallen in many countries, whereas those in young people have risen (Hawton & van Heeringen, 2009).

Risk factors for suicide

Important contributors to self-harm and suicide include genetic vulnerability and psychiatric, psychological, familial, social and cultural factors. For instance, the relationship between psychiatric disorders and adolescent suicide is well established. Mood disorders, substance abuse and prior suicide attempts are strongly related with youth suicides (Pelkonen & Marttunen, 2003). The effects of media and congestion are also relevant, with the internet having an important contemporary role, as well as family history of suicidal behaviour, family adversity and upbringing, social alienation, exposure to suicidal behaviour by others and in the media, and availability of means (Hawton et al., 2012; Hawton & van Heeringen, 2009; Pelkonen & Marttunen, 2003).

The progression from suicidal ideation to self-harm and then to suicide is by no means absolute. Self-harm may escalate and this may be a marker for subsequent suicide: Suicide risk among self-harm patients is hundreds of times higher than in the general population (Owens et al., 2002). The risk of suicide attempt is significantly increased in those with suicidal ideations and planning, and risk of completed suicide is increased in patients who abscond from medical care or take precautions against discovery. Providing continuity of care for high-risk youth is a challenge, since they are often noncompliant and commonly drop out or terminate their treatment prematurely (Pelkonen & Marttunen, 2003).

Reportedly less than half of young people who have committed suicide have received psychiatric care (Pelkonen & Marttunen, 2003).

Approaches to suicide prevention

Prevention of self-harm and suicide needs both universal measures aimed at young people in general and targeted initiatives focused on high-risk groups (Hawton et al., 2012). The main target of effective prevention of youth suicide is to reduce suicide risk factors. In particular, recognition and effective treatment of psychiatric disorders, e.g. depression, as well as restriction of access to means for suicide, are essential in preventing child and adolescent suicides (Pelkonen & Marttunen, 2003). Furthermore, available evidence suggests that various treatment modalities are useful in the treatment of suicidal youths, e.g. cognitive behavioural therapy and specialized emergency room interventions.

Efforts to prevent subsequent attempts at suicide have not generally been successful, and many children and adolescents are not receiving treatment for the mood and other psychiatric disorders that are risk factors. Evaluation of suicide risk should be carried out regularly in order to attempt early intervention as part of suicide prevention programmes.

To address this, a consortium of child mental health specialists across Europe, led by Dr. Paramala Santosh, London, UK, worked as part of the EU FP7 funded Suicidality: Treatment Occurring in Paediatrics (STOP) project, and specifically developed the Suicidality: Treatment Occurring in Paediatrics (STOP) Suite of Suicidality Measures, measuring suicidality, medication side effects, and risk and protective factors. These patient-reported outcome measures (PROMS) are hosted on the so called HealthTracker, a web-based multimedia health monitoring system. The STOP project is being piloted in children and adolescents to identify whether the patient reported measures can pick up suicidal ideation and behaviour allowing for alert systems to be set up and to warn clinicians about increased suicidal risk, resulting in early intervention, especially when new medication is initiated.

As part of this project, a detailed review of psychosocial factors associated with suicidality in children and adolescents was conducted. Studies of psychological factors, life events, temperamental factors, medication-related factors, and associated medical problems were reviewed. According to the findings, the majority of youth who have completed suicide had significant psychiatric problems, including depressive disorders and substance abuse disorders. Stressful life events and medical conditions were often reported to precede a suicide and/or suicide attempt. Youth suicide was marked by a distinct male preponderance, and some temperamental factors may mediate suicide risk.

Another aspect of the web-based HealthTracker monitoring system hosting the STOP Suicidality measures is its use in pharmacovigilance to detect medication-associated suicidality when new drugs are introduced into the market.

Conclusion

Suicide and suicide attempts by children and adolescents are today a major public health problem. During the mid-adolescent years, the incidence of suicide attempts reaches a peak and mortality from suicide is the third leading cause of death.

Major risk factors for suicidal behaviour include genetic vulnerability, mental disorders (e.g. mood disorders, substance abuse), family adversity, social alienation, family history of suicidal behaviour, exposure to suicidal behaviour by others and in the media, availability of means, and previous self-harm.

Since less than half of young people who have committed suicide have received psychiatric care, broad prevention strategies are paramount needs in healthcare and social services. In particular, clinicians need to know how to identify individuals at greatest risk for suicide.

As part of suicide prevention, evaluation of suicide risk should be carried out on a regular basis in order to attempt early intervention. The EU-funded Suicidality: Treatment Occurring in Paediatrics (STOP) Programme was developed to provide suicidality measures, and is being piloted in children and adolescents to alert clinicians about increased suicide risk and prompt early intervention.


References
1. Suicidality: Treatment Occurring in Paediatrics (STOP) Project - EC FP7 Grant Agreement No 261411

2. Hawton K & Heeringen KV. Suicide. Lancet 2009;373:1372-81
3. Hawton K, Saunders KE, O´Connor RC. Self-harm and suicide in adolescents. Lancet 2012; 379:2373-2382

4. Nock MK, Borges G, Bromet EJ, et al. Cross-national prevalence and risk factors for suicidal ideation, plans, and attempts in the WHO World Mental Health Surveys. Br J Psychiatry 2008a;192:98-105

5. Nock, MK., Borges, G., Bromet, E.J., Cha, C.B., Kessler, R.C., Lee, S. Suicide and suicidal Behavior. Epidemiology Review 2008b;30:133-154

6. Owens, D., Horrocks, J., House, A. Fatal and non-fatal repetition of self-harm: systematic review. British Journal of Psychiatry 2002;181:193-9

7. Pelkonen M, Marttunen M. Child and adolescent suicide: epidemiology, risk factors, and approaches to prevention. Paediatr Drugs 2003;5:243-65

8. U.S. Department of Health and Human Services, Public Health Service; 2001. National Strategy for Suicide Prevention: Goals and objectives for action. Rockville, MD: Author.

9. United States Department of Health and Human Services. The Surgeon General's call to action to prevent suicide, 1999 [online]. Available from URL: www.surgeongeneral.gov/library/calltoaction/calltoaction.pdf [Accessed 2007 Apr 24]

10. United States Department of Health and Human Services. The Surgeon General's call to action to prevent suicide, 1999 [online]. Available from URL: http://www.surgeongeneral.gov/library/calltoaction/calltoaction.pdf [Accessed 2007 Apr 24]

11. World Health Organisation. Suicide rates, country reports and charts [online]. Available from URL: www.who.int/mental_health/prevention/suicide/country_reports/en/index.html [Accessed 2006 Jun 2]

Correspondence:

Dr. Paramala J. Santosh, Dip NB (Psych), MD, PhD, FRCPsych Child and Adolescent Mental Health Services Clinical Academic Group, South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, Maudsley Hospital, De Crespigny Park, London SE 5 8AZ, United Kingdom

E-mail: paramala.1.santosh@kcl.ac.uk

Sonja Mak | EurekAlert!
Further information:
http://www.ecnp.eu/

More articles from Studies and Analyses:

nachricht New study: How does Europe become a leading player for software and IT services?
03.04.2017 | Fraunhofer-Institut für System- und Innovationsforschung (ISI)

nachricht Reusable carbon nanotubes could be the water filter of the future, says RIT study
30.03.2017 | Rochester Institute of Technology

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Making lightweight construction suitable for series production

More and more automobile companies are focusing on body parts made of carbon fiber reinforced plastics (CFRP). However, manufacturing and repair costs must be further reduced in order to make CFRP more economical in use. Together with the Volkswagen AG and five other partners in the project HolQueSt 3D, the Laser Zentrum Hannover e.V. (LZH) has developed laser processes for the automatic trimming, drilling and repair of three-dimensional components.

Automated manufacturing processes are the basis for ultimately establishing the series production of CFRP components. In the project HolQueSt 3D, the LZH has...

Im Focus: Wonder material? Novel nanotube structure strengthens thin films for flexible electronics

Reflecting the structure of composites found in nature and the ancient world, researchers at the University of Illinois at Urbana-Champaign have synthesized thin carbon nanotube (CNT) textiles that exhibit both high electrical conductivity and a level of toughness that is about fifty times higher than copper films, currently used in electronics.

"The structural robustness of thin metal films has significant importance for the reliable operation of smart skin and flexible electronics including...

Im Focus: Deep inside Galaxy M87

The nearby, giant radio galaxy M87 hosts a supermassive black hole (BH) and is well-known for its bright jet dominating the spectrum over ten orders of magnitude in frequency. Due to its proximity, jet prominence, and the large black hole mass, M87 is the best laboratory for investigating the formation, acceleration, and collimation of relativistic jets. A research team led by Silke Britzen from the Max Planck Institute for Radio Astronomy in Bonn, Germany, has found strong indication for turbulent processes connecting the accretion disk and the jet of that galaxy providing insights into the longstanding problem of the origin of astrophysical jets.

Supermassive black holes form some of the most enigmatic phenomena in astrophysics. Their enormous energy output is supposed to be generated by the...

Im Focus: A Quantum Low Pass for Photons

Physicists in Garching observe novel quantum effect that limits the number of emitted photons.

The probability to find a certain number of photons inside a laser pulse usually corresponds to a classical distribution of independent events, the so-called...

Im Focus: Microprocessors based on a layer of just three atoms

Microprocessors based on atomically thin materials hold the promise of the evolution of traditional processors as well as new applications in the field of flexible electronics. Now, a TU Wien research team led by Thomas Müller has made a breakthrough in this field as part of an ongoing research project.

Two-dimensional materials, or 2D materials for short, are extremely versatile, although – or often more precisely because – they are made up of just one or a...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Expert meeting “Health Business Connect” will connect international medical technology companies

20.04.2017 | Event News

Wenn der Computer das Gehirn austrickst

18.04.2017 | Event News

7th International Conference on Crystalline Silicon Photovoltaics in Freiburg on April 3-5, 2017

03.04.2017 | Event News

 
Latest News

Bare bones: Making bones transparent

27.04.2017 | Life Sciences

Study offers new theoretical approach to describing non-equilibrium phase transitions

27.04.2017 | Physics and Astronomy

From volcano's slope, NASA instrument looks sky high and to the future

27.04.2017 | Earth Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>