A new study has identified numerous, complex factors and a pattern of cumulative risk and final straw stresses that may contribute to suicide risk in children and young people. Cathryn Rodway outlines what the findings tell us and points to issues that policymakers should consider for this tragic cause of death in young people.
Along with colleagues from the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, I have been involved in the first comprehensive national study of suicide of its kind looking at children and young people under 20 in England. This report is the first phase of the research. Next year, we will be publishing a larger study widened to all countries in the UK and including those under 25 years of age who die by suicide. Our intention at that time will be to include more detailed recommendations for services and policymakers.
This report outlines the events and circumstances prior to suicide, extracted from a range of official investigations and inquiries on 130 people in England who died by suicide between January 2014 and April 2015. What we have identified is that there are 10 common themes that appear to contribute to suicide risk in children and young people, including bereavement, bullying, exams and physical health conditions such as acne and asthma.
Bereavement, physical health and exam pressures
We found that 28% of the young people who died had been bereaved and in 13% of cases there had been a suicide by a family member or friend. We also found that in 36% of the sample, the young person had a physical health condition such as acne or asthma. Twenty nine percent of young people who were in education were facing exams or exam results when they died. Four died on the day of an exam, or the day after. This may indicate that schools and education policy makers need to look more closely at the pressures young people face at this time and offer greater support during the exam period. However, in the long term, education is an important protective factor against suicide risk.1 While our study suggests that, for a minority, academic pressures may contribute to suicide risk, this is often accompanied by other complex issues, and is not the case for most young people.
During the next phase of this study we aim to gather a fuller understanding of some of these factors so that we can begin to offer recommendations for suicide prevention for various services, including the education system, primary care, Child and Adolescent Mental Health Services (CAMHS), and the youth justice system on managing some of these childhood events that cause an insurmountable level of stress for some young people.
A complex picture
Our report found the suicide rate in people under 20 is low overall but rose sharply from the mid- to late teens and that numerous experiences and stresses were likely to have contributed to suicide risk in children and young people.. So, for example, for many longstanding family adversity such as drug misuse by a family member or domestic violence seems to have been followed by difficulties in other areas of life as they got older such as excessive alcohol use, complicated by mental health problems. One event following this pattern of cumulative risk may then have acted as a ‘final straw’, for example, an exam or relationship breakdown. This indicates that there’s a role for parents, carers, schools and GP services to play in being aware of the potential impact of these issues as early as possible to provide protection and guidance for these vulnerable youngsters.
Internet use related to suicide was found in 23% of the deaths. This was defined as either searching for information about suicide methods, being a victim of online bullying or posting suicidal thoughts online. We found that bullying overall had occurred in 22% of cases, mostly face-to-face rather than online.
Over twice as many males as females died by suicide and there were five deaths in those aged under 14. Hanging was the most common method, accounting for 63% of deaths followed by jumping from a height or in front of a train – methods that show a strong lethal intent. Excessive alcohol or illicit drug use was more common in older teens, and 54% of children and young people overall had previously self-harmed. In the week before they died, 10% had self-harmed and 27% had told someone of suicidal ideas. 43% had no contact with any services.
Future research and policy implications
Our study shows that self-harm is common prior to suicide, in line with previous research that has established a strong association between self-harm and increased future risk of suicide in all ages.2,3 However, a large minority (46%) had not previously self-harmed and furthermore, many of the young people who died by suicide had not expressed recent suicidal ideas. We are keen to stress to those involved in a young person’s life that an absence of suicidal ideas or self-harm cannot be assumed to show a lack of risk. We would urge agencies to contribute to suicide prevention by recognising the pattern of cumulative risk and final straw stresses that lead to suicide. Agencies working more closely together to share information could help to build up a more comprehensive picture of what is happening in a young person’s life, and what their individual risk might be.
At this stage our research indicates that it is crucial that there are improved services for self-harm and access to mental health care such as CAMHS.
This study highlighted a variety of common themes and it is clear that schools, primary care, social services and youth justice all have a role to play. Next year when we’ve analysed a larger sample we will be better placed to provide more detailed policy recommendations.
We believe research into this difficult subject to be long overdue and of vital importance. All those involved in young people’s lives need to be alert to the risks, in particular when these accumulate over time. Strategies to support communication between involved adults and young people are vital.
- The full report is available to read here.