Suicide under the age of eighteen: a 10-year retrospective study

Notifications, hospitalizations and deaths from self-harm in children in Brazil's national health systems

There are virtually no statistics on childhood suicidal behavior globally. This setting can be partly explained by the social representation of joy in this early phase of life. This paper aims to analyze information on self-harm reports, hospitalizations, and deaths among children aged 5-9 years in Brazil to know its magnitude and distribution from 2006 to 2017, based on data from national health information systems. The results show 58 deaths of Brazilian children with intentional self-harm, primarily male, white, and nine years old. Hanging was the most commonly used mechanism for children to kill themselves. A total of 1,994 hospitalizations were recorded for suicide attempts in children in the period 2006-2017, with a predominance of males in all regions. Regarding notifications, most refer to children between 8 and 9 years of age, black and female, emphasizing self-poisoning. Evidence that any suicidal behavior in childhood is strongly associated with attempted or completed suicide in adolescence and adulthood is one of the main indications of the need to prevent this behavior in the first decade of life.

Suicidal deaths in elementary school students in Korea

BACKGROUND

The purpose of this study was to determine the characteristics of childhood suicidal deaths among elementary school students that occurred from 2011 to 2015 in Korea.

METHODS

The report form of each suicide case by the teacher in charge to the Education Ministry was reviewed retrospectively.

RESULTS

There were 19 suicidal deaths (12 boys, 7 girls) in elementary school students. The youngest case was a third grader (n = 1). Jumping from heights (n = 12) was the most frequently used method. Most suicides (n = 12) were committed in their homes.

CONCLUSION

These results highlight the alarming trend of early suicidal deaths and the importance of early suicide prevention strategies, especially in schools.

Pattern of unnatural deaths among children: An autopsy study

This study was conducted at the M. S. Ramaiah Medical College, Bangalore, between October 2007 and September 2009 to analyse the age and sex distribution of unnatural deaths in children, patterns and manner of death. Detailed information regarding the circumstances of death was sought from the relatives, friends and police. The scene of occurrence was visited, and photographs of the scene of occurrence were examined in relevant cases. Unnatural deaths in children constituted 6.62% of the total autopsies conducted. The majority of childhood deaths were in the age group of 15-18 years of both sexes constituting 46.88%. Males constituted 55.22% of cases. Suicide accounted for 40.63% of the cases. Most children committed suicide by hanging (82.05%). The main reason was academic failure and some of the cases were accidental (48.96%). Road traffic accidents accounted for 26.04% of the cases, where most children were pedestrians (56%). Drowning accounted for 15.63% of the cases. Most of the children drowned while playing near ponds (83.33%). Homicide accounted for 9.36% of the cases - either killed by their mother as part of a pedicide-suicide event or by the father, and in two cases the children were sexually abused before being killed.

Suicidal childhood deaths with firearms in Antalya, Turkey

The purpose of this study was to determine the characteristics of suicidal childhood deaths with the use of firearms that occurred from 2000 to 2009 in Antalya. The autopsy reports of the Antalya branch of the Turkish Forensic Medicine Council and judicial records were reviewed retrospectively. There were 60 suicidal deaths between 0 and 18 years of age. Firearms were used in 20 cases (11 males, 9 females). The shotgun (n = 15) was the most frequently used weapon. The site of bullet entries were the chest (n = 6), abdomen (n = 5), right temple (n = 5), mouth (n = 2) and neck (n = 2). Most suicides (n = 16) were in the home. In contrast to many other studies, the most frequently used weapon for suicides was the shotgun in this study.

Adolescent Russian roulette deaths

Adolescence, between the ages of 10 and 19 years, is a unique period both physically and emotionally. During this time of life, individuals are known to experiment and engage in risky behavior, sometimes with unforeseen morbidity and mortality. We also see suicide emerge as a manner of death in this age group. The most common method is gunshot wound and sometimes in the form of Russian roulette. Few studies have looked at deaths by Russian roulette, the victims, and scenarios. In particular, no study examines the adolescent victim of Russian roulette. To better understand and classify this entity, adolescent Russian roulette autopsy cases over a 20-year period were examined looking at the victims, scenarios, autopsy findings, cause and manner of death, and the weapons. All victims were males, ages 13 to 19 years, with a Black-to-White ratio of 1:1. No victim had a previous psychiatric history. Toxicology was positive for alcohol and/or marijuana in 50% of the victims. Friends were present when the victim shot himself which occurred in the home the majority of the time. In all but 1 case, premeditation of the game was involved as the victim provided the weapon for the roulette. The cause of death was gunshot wound to the head (6 to the right side, 1 to the mouth, 1 to the forehead), and the manner of death was suicide in 6 cases and accident in 2 cases. A review of the literature discusses the adolescent victim, suicide, and Russian roulette.

Suicide in juveniles and adolescents in the United Kingdom

BACKGROUND

Suicide is a leading cause of death among youths. Comparatively few studies have studied recent trends over time, or examined rates and characteristics of service contact in well-defined national samples.

METHODS

Data on general population suicides and mid-year population estimates were used to calculate suicide rates (per 100,000/year) among youths aged 10-19 years in the United Kingdom. We then determined the proportion of youths who had been in mental health service contact in the year prior to death. Social and clinical data were collected via questionnaires sent to clinicians who had provided care.

RESULTS

The general population rate of suicide was higher in males than females, and was higher in 15-19-year-olds compared to 10-14-year-olds. Suicide rates for 10-19-year-olds declined by 28% between 1 January 1997 and 31 December 2003 (compared with an 8% reduction in those aged >19 years); the fall was particularly marked for males. Mental health service contact was low at 14% (compared with 26% for adults), especially for males (12%). Youths in mental health contact were characterised by: diagnosis of affective disorder, mental illness history, residential instability, self-harm, and substance misuse. Over half of youths were living with parents and one-fifth were in full-time education.

CONCLUSIONS

The suicide rate for 10-19-year-olds in the UK appeared to fall between 1997 and 2003. Further monitoring of suicide rates is needed to determine whether this trend has continued for the most recent years (e.g., 2004-7). The fall in rates may have been related to socio-economic or clinical factors. The rate of contact with services was low compared to adults, particularly in males. This is concerning because young males have the highest suicide rate in the UK. Suicide prevention in young people is likely to require a multi-agency approach.

Child and adolescent victims in forensic autopsy: a 5-year retrospective study

Children of more than 3 years of age and adolescents have been largely overlooked in the forensic literature, especially the 4-9 age group. Thus, the present study was undertaken to address this particular issue of child and adolescent victims in forensic autopsies. On a 5-year period (2000-2004) in Quebec province (Canada), all forensic autopsy cases of children and adolescents from 4 to 19 years of age were retrospectively studied. A total of 223 cases of child and adolescent deaths (148 males, 75 females; 6.6% of all forensic autopsies) were reviewed. Age, gender, manner of death and cause of death were analyzed for all victims organized into three groups of age: 4-9, 10-14, and 15-19. Moreover, homicide cases (n = 54) are further analyzed in terms of method(s) used (firearm, sharp force, asphyxia, blunt force, intoxication). This 5-year retrospective study may contribute to a better understanding of typical deaths in the 4-19 group of age and therefore, bring a working basis for the forensic pathologist or medical examiner/coroner.

Mortalities among children and adolescents in manipal, southern India

OBJECTIVE

To describe the epidemiology and trends of traumatic deaths among children and adolescents in Manipal, Southern India.

METHODS

Analysis of all trauma deaths in children and adolescents aged between 1 and 19 years, autopsied between January 1994 and December 2005. The study is based on autopsy records, information furnished by the police, and chemical analysis report.

RESULTS

There has been a substantial decline in the incidence of traumatic deaths among children and adolescents during 1994 to 2005. Road traffic injuries were responsible for maximum mortalities (38.4%), followed by those because of burns (24.9%) and poisoning (15.9%). Males comprised 59.6% of cases. Male-to-female ratio was 1.5:1. Males predominantly died of traffic injuries (45.2%), whereas females as a result of burns (37.4%). There was more than two-fold increase in injury-related mortalities from childhood to adolescence (1:2.3).

CONCLUSION

Among children and adolescents, traffic injuries and burns are responsible for maximum injury-related mortalities in males and females, respectively. More injury reducing measures are required for effective reduction in traumatic deaths.

Russian roulette and risk-taking behavior: a medical examiner study

Fatal Russian roulette refers to death following an act of extreme bravado in which the individual spins the cylinder of a revolver loaded with at least one cartridge, aims the muzzle at the head, and pulls the trigger. The majority of victims are men younger than 30 years who, in the presence of others, are under the influence of ethanol or other drugs. This is a 10-year (1993-2002) retrospective review of self-inflicted gunshot wounds of the head, among which we culled and paid special attention to cases of Russian roulette, at the Medical Examiners' Offices in Kentucky. Of the 24 incidents of Russian roulette, the majority of victims were white (79.2%), and all were men between 14 and 47 years with a mean age of 24.8 years. Compared with other cephalic firearm suicides, the subjects engaging in Russian roulette were significantly more likely to have elevated blood levels (> or = 0.1%) of ethanol along with various drugs detected in urine. Although the presumed intent of the risky act is to survive, Russian roulette is deemed to be suicide, which is based on a comprehensive understanding of the inherently deliberate, volitional actions of the decedent.

Suicides in the Young People of Geneva, Switzerland, From 1993 to 2002

Suicides in Geneva in those less than 25 years old, from 1993 to 2002, were reviewed. Scenes investigations, autopsy findings, toxicology results, and psychiatric history (when available) were examined. There were 65 cases. The average annual suicide rate was 11/100,000. Seventy-seven percent were male, and 23% were female. The youngest was 12 years old and most of the victims were 18 years old and over (89%). For men, the use of firearms was the most common method (38%), followed by fall from height (16%) and drowning (10%). For women, fall from height was the most frequent (40%), followed by firearms and medication overdoses (20% each), hanging (13%), and drowning (7%). Toxicological analysis was performed in 41% of the cases and showed that alcohol was present in 26% and other drugs in 67% of these cases. The most common drugs present were benzodiazepines, cannabis, and cocaine.

Suicide in India: a four year retrospective study

Suicide is one of the ten leading causes of death in the world, accounting for more than a million deaths annually. The purpose of the study was to identify the risk groups. In the four-year period from January 2000 to December 2003, 588 suicide victims were autopsied. Information was obtained by interviewing the acquaintances of the victim, perusal of hospital records and the autopsy findings. All the cases were analyzed as to sex, age, and methods of suicide, seasonal variation, diurnal variation and other sociological aspects. The present study depicts a suicidal rate of 11.76 per 100,000 population. Males and females were almost equally the sufferers. The largest number of victims were found in the age group of 21-30 years. Hanging and poisoning constituted the two major modes of suicides (63%). Majority of the victims were mentally sound, married and were from rural background. Victims were mostly drawn from low socioeconomic status (48%). Less educated or illiterates were usually the victims. Suicidal note was detected in 5% of cases. Suicidal tendency and alcohol intake could not be encountered in most of the cases. Indoor incidence was almost double of the outdoor incidence, mostly seen in rainy season (43%) and occurred almost equally during day and night. Financial burden (37%) and marital disharmony (35%) were the principal reasons for the suicide.

Adolescent and Young Adult Suicide: A 10-Year Retrospective Review of Kentucky Medical Examiner Cases

The compilation of all suicidal causes of death attained the third highest ranking of mortality between the ages of 15 and 24 following unintentional deaths and homicide in the United States, accounting for approximately 4000 deaths in 2002. A variety of biopsychosocial factors may contribute to adolescent suicidal behavior, including psychiatric disorders, risk-taking behaviors, and lack of a cohesive family unit. The authors conducted a 10-year (1993-2002) retrospective review of 108 Medical Examiner cases of suicide ages 11-17 and 358 cases ages 18-24 in Kentucky, which represents two thirds of the Coroner cases in the state. The majority of victims were male and Caucasian. The major causes of death were the same for the two age groups, specifically, firearm injury (72.2% and 70.7%), hanging (22.2% and 18.7%), and drug intoxication (2.8% and 5.3%). An integrated Coroner-Medical Examiner system profits in the public health arena by providing collaborative research data for policy decisions. The prevalence of youth suicide by firearm should prompt further discussion regarding ways to better identify high-risk adolescents and young adults and restrict pediatric access to unsecured household firearms.

Suicide in Children and Adolescents

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.

Suicide among children and adolescents in South Delhi (1991-2000)

OBJECTIVE

Suicide among youth is of great concern and a subject requires thorough study to formulate prevention strategy. In this paper the incidence and trends of suicide among children and adolescent of South Delhi have been reported.

METHODS

A retrospective analysis was carried out on 222 cases of suicidal deaths pertaining to age group of 10-18 years, the postmortem examination on the body of which were conducted in Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, New Delhi during the period from 1st January 1991 to 31st December 2000. The particular of cases were analyzed according to age group, sex, method used and causes of committing suicide.

RESULTS

Out of 222 cases 123(55.4%) were of girls (Female: Male 1.24:1). Commonest age group involved was 15-18 years in both the sexes. Commonest method used for committing suicide was hanging (57% in girls, 49.5% in boys) followed by poisoning (37.4% in girls, 49.5% in boys).

CONCLUSION

Methods used to commit suicide are widely available and are difficult to restrict. Therefore, suicide prevention strategy based on risk factors could be more effective rather than limiting the access to methods.

Suicidal deaths in childhood and adolescence

Suicide has been reported as the second or third most common cause of death in children and adolescents worldwide. In this study, cases of under the age of 19 years submitted to the Institute of Forensic Medicine, First Specialization Board between 1996 and 2000 as suicides by the Board were evaluated retrospectively. The cases included in this study were the cases bearing locally questionable components, so had been submitted to the evaluations by the Board in order to eradicate the doubts. A total of 43 cases were investigated regarding age, gender, cause of death, manner of death, place of death, time of death, and the risk factors. Of the 43 cases evaluated, 31 cases were female and 12 cases were male. The notable suicide method was found to be firearms. Although it was clear that that not all of the suicide cases in this age group had been submitted to the Institute of Forensic Medicine, the most striking result of this study, nevertheless, was that girls constituted the 72% of suicidal deaths in this age group.

Suicide in children and adolescents at a province in Turkey

Despite the well-documented increases in the rate of completed suicide among children, accurate knowledge of the characteristics of these suicides is limited. We examined all suicides by children and adolescents in Diyarbakir during 1999 and 2001. All of the cases were analyzed regarding the age, sex, method and location of suicide, time of year, and predictive factors. There were 56 children aged 11 through 19 years. Adolescents between 15 and 19 years of age constituted the overwhelming number (87%) of all the childhood suicides. Female children and adolescents predominated among the suicide victims (71%). The most frequent means of suicide were firearms (43%), hanging (28%), and jumping (16%), respectively. The majority of suicides occurred at the decedent's home (88%). Reasons identified were mainly psychiatric disorders, followed by troubles within the family. A prior suicide attempt or a note that was left by the decedent and elucidated the reason for the suicide was rare. There was no seasonal difference in rates of suicides.

Depression in adolescence

Major depressive disorder is a common problem for adolescents. It has a wide array of symptoms affecting somatic, cognitive, affective, and social processes. Academic failure, poor peer relationships, behavioral problems, conflict with parents and other authority figures, and substance abuse are some of the consequences of major depressive disorder in this age group. Effective treatments include nontricyclic antidepressants and coping skills training. The nurse is key to depression detection and suicide prevention, especially in primary care settings. Through psychoeducation, nurses can promote recovery from depression by encouraging a healthy lifestyle, enhancing social skills, and assisting the adolescent to identify and use sources of social support. These measures can prevent premature death and promote long-term well-being of the adolescent.

Suicide in children, adolescents and young adults

As suicides of children, adolescents and young adults occur very seldom and only few case reports and more comprehensive studies are available in forensic literature, the autopsy records of the Bonn Institute of Forensic Medicine and the database of the Bonn police authorities from 1989 to 1998 were retrospectively analysed for this phenomenon. This search revealed 37 respective suicides involving 23 male (62%) and 14 female (38%) victims. The ages ranged from 10 to 21 years with the prevalence sharply increasing in adolescents and young adults. Independent from sex, the victims almost unexceptionally applied hard suicide methods like hanging, running over by a train or jump from the height. As for the psychological background, current conflicts with a sweetheart, within the family or at school on the background of mental illness or chronically disturbed family structures were encountered as prevailing factors.

Child and young adolescent suicide in New Zealand

OBJECTIVE

To describe the epidemiology and characteristics of all suicide deaths among under 15-year-olds in New Zealand over a 10-year period.

METHOD

In a 10-year retrospective study the features of all 61 children and young adolescents aged less than 15 years who died by suicide in New Zealand from 1989 to 1998 were examined by review of coronial files.

RESULTS

Suicide among under 15-year-olds is very rare but increasing. Suicide risk increases with age: the majority of those who die are aged 14 years (57.4% of the total) or 13 years (26.2%). Boys (72.1%) and Maori (57.4%) predominate. Most suicides occurred in children not living in intact biological families (67.2%). Hanging was the predominant method (78.7%). One in three children left suicide notes. One in four had a history of contact with social welfare authorities. There was a family history of suicide in 10% of cases. A minority had a documented history of prior suicide attempts (13.1%) or mental health problems (23%). One in four (23%) was reported to have made threats of suicide within the year prior to their death. A majority of deaths appeared to have been precipitated by relatively minor family arguments or disciplinary events, which, however, occurred in the context of actual or anticipated disruptions or transitions in family living arrangements or school circumstances, or severe family problems.

CONCLUSIONS

In general, the impression of young adolescent suicide was of a disadvantaged, vulnerable and distressed group of adolescents growing up in extremely difficult circumstances. Maori children predominate in this group. There is clearly a need to verify these impressions with an in-depth investigation of the familial and social circumstances of children who die by suicide. Such investigations might best be conducted by annual mortality review and monitoring of all young adolescent suicides.

Elderly suicide: a 10-year retrospective study

The suicide rate in the 65-year and older age group has been increasing since 1980. The elderly attempt suicide less often than younger people but are successful more often. The authors retrospectively reviewed all cases referred to the Forensic Pathology Section of the Medical Examiners' Office at the Medical University of South Carolina (Charleston, SC) from January 1988 through December 1997. The cases of suicide in victims 65 years and older totaled 78, accounting for 11.5% of all suicides reviewed. Of these 78 cases, 41% were autopsied and 59% were externally examined. All of the cases were initially analyzed as to age, race, sex, and method of suicide. Files also were reviewed to determine time of year of the suicide, toxicology results, psychiatric history, social history, medical history, and whether a suicide note was left. The ages of these suicide victims ranged from 65 to 94 years; men comprised 85% of the victims, and whites, 94%. The male-to-female and white-to-black ratios were 6:1 and 15: 1, respectively. The average age of the victim was 73 years. Gunshot wound was the most common method of suicide, accounting for 80.7% of the cases. Other methods included overdose (6.4%), hanging (3.8%), fall from height (2.6%), incised wounds (2.6%), drowning (2.6%), and carbon monoxide poisoning (1.3%).