Citation

Hawton KE, James A. Br. Med. J. BMJ 2005; 330(7496): 891-894.

Affiliation

Centre for Suicide Research at the University of Oxford, Oxford, UK.

Copyright

(Copyright © 2005, BMJ Publishing Group)

DOI

10.1136/bmj.330.7496.891

PMID

15831877

PMCID

PMC556165

Abstract

Deliberate self harm ranges from behaviours with no suicidal intent (but with the intent to communicate distress or relieve tension) through to suicide. Some 7%-14% of adolescents will self harm at some time in their life, and 20%-45% of older adolescents report having had suicidal thoughts at some time. Suicide occurs relatively rarely under the age of 15 years, although prevalence is likely to be underestimated because of reluctance of coroners to assign this verdict. A large proportion of open verdicts ("undetermined cause") are, in fact, suicides. Suicide rates are far higher in male than female adolescents. Until the past five or six years in England and Wales suicide rates were rising substantially in 15-19 year old and 20-24 year old young men, but then they began to fall somewhat in the older age group. The lack of change in female suicide rates may reflect differential effects of social change on gender roles.  Psychological postmortem studies of suicides show that a psychiatric disorder (usually depression, rarely psychosis) is present at the time of death in most adolescents who die by suicide. A history of behavioural disturbance, substance misuse, and family, social, and psychological problems is common. There are strong links between suicide and previous self harm: between a quarter and a half of those committing suicide have previously carried out a non-fatal act. It can be difficult to identify young people at risk of self harm, even though many older adolescents who are at risk consult their general practitioners before they self harm. Suicidal ideation is relatively common among adolescents; precipitating events may be non-specific; acts of self harm are often impulsive; and secrecy and denial are common. Effective preventive care requires involvement of multiple agencies -- for example, mental health services and social services. These agencies need to work in a coordinated way with adolescents thought to be at risk, including those with severe psychiatric disorders.