Relation between attempted suicide and suicide rates among young people in Europe

Suicidal Behavior in Four Ethnic Groups in The Hague, 2002–2004

Background: Suicidal behavior is a severe public health problem. Aims: To determine the rates of attempted and completed suicide among ethnic groups in The Hague, The Netherlands (2002–2004). Methods: By analyzing data on attempted and completed suicide (from the psychiatric department of general medical hospitals; the psychiatric emergency service and the municipal coroners). Results: Turkish and Surinamese females aged 15–24 years were at highest risk for attempted suicide (age-specific rate 545 / 100,000 and 421 / 100,000 person-years, respectively). Both rates were significantly higher than in the same age group of Dutch females (246 / 100,000 person-years). Turkish (2%) and Surinamese (7%) had lower repeat suicide-attempt rates than did Dutch (16%) females aged 15–24. Significantly lower suicide-attempt rates were found for Surinamese than for Dutch females aged 35–54 years. Differences were not explained by socioeconomic living conditions. The ratio fatal/nonfatal events was 4.5 times higher in males than in females and varied across age, gender, and ethnicity strata. Completed suicide was rare among migrant females. No completed suicides were observed in the Turkish and Surinamese females aged 15–24 years. Conclusions: The study demonstrates a high risk of attempted suicide and a low risk of completed suicide among young Turkish and Surinamese females.

Self-mutilation and suicidal behaviour in children and adolescents: prevalence and psychosocial correlates: results of the BELLA study

OBJECTIVE

To investigate the prevalence and psychosocial correlates of suicidal behaviour in a representative sample of children and adolescents in Germany.

METHODS

Suicidal behaviour was assessed in the BELLA study in a sample of 2,863 families with children aged 7-17 using the corresponding questions from the child behavior check list and the youth self report. Self-reported as well as parent-reported measures of overall mental health problems, anxiety, depression, aggressive and delinquent behaviour, attention deficit-/hyperactivity as well as health-related quality of life were also administered.

RESULTS

Self-mutilation and/or suicidal attempts within the last six months were reported by 2.9% of the adolescents 11-17 years of age. Suicidal thoughts were reported by 3.8% of the same group of adolescents. The prevalence rates reported by the parents were 1.4% for self-mutilation and/or suicidal attempts and 2.2% for suicidal thoughts. The prevalence of parent-reported self-mutilation/suicidal attempts in children below 11 years of age was very low. Youth reporting suicidal behaviour were older than youth not reporting suicidal behaviour. Children and adolescents exhibiting suicidal behaviour reported significantly more general mental health problems, depressive symptoms, anxiety, and hyperactivity as well as lower health-related quality of life.

CONCLUSIONS

There is a strong connection between suicidal behaviour and emotional and behavioural problems, especially with symptoms of depression, anxiety and hyperactivity. The association observed between attention deficit-/hyperactivity and suicidal behaviour requires further investigation. The differences in the extent of reported suicidal behaviour in adolescents between the self- and parent-ratings and the degree of confidentiality in the collection of the data are subjects for future research.

Suicide by jumping from bridges and other heights: social and diagnostic factors

The goal of the study was to determine social and diagnostic characteristics of persons who end their lives by jumping from heights and to compare the characteristics of those who jump from bridges with those jumping from other sites. Data on suicide in Switzerland between 1990 and 2003 were collected from the Swiss Federal Statistical Office and from local authorities. Persons who jumped from heights in general were more likely to suffer from schizophrenia than those who used other methods. Persons who jumped from bridges were younger than those committing suicide by other methods. Compared with those who jumped from other sites, subjects were on average 14.3 years younger and more often male. Individuals who jumped from bridges close to psychiatric hospitals were more likely to suffer from psychiatric illness. Individuals who jump from bridges differ in certain characteristics from those who jump from other sites. For future classification it may be helpful to distinguish suicides from bridges from suicides from other heights. For prevention of suicide from bridges, attention should be paid to characteristics of young persons at risk.

Pregnancies in high psychosocial risk groups: research findings and implications for early intervention

Besides the well-known risk factors for youth suicidal behavior, recent evidence suggests that risk for youth suicidal behavior can be determined even very early in life, during the prenatal and perinatal period. Low birth weight and short birth length adjusted for gestational age were found to increase the risk for suicidal behavior, particularly by violent means. Several parental factors like low parental socioeconomic status, teenage and single parenthood, multiparity and parental psychopathology, substance abuse and suicidal behavior have been linked to an increase in youth suicidal behavior. Effective collaboration among the sectors within health care and social services is crucial for early detection and adequate intervention.

Deliberate self-harm in young people: differences in prevalence and risk factors between the Netherlands and Belgium

BACKGROUND

This study aimed to examine prevalence and risk factors of deliberate self-harm in Dutch and Dutch-speaking Belgian adolescents.

METHOD

A cross sectional survey using an anonymous self report questionnaire was performed in both countries. Data on 4,431 Belgian and 4,458 Dutch 15-16 year-old school pupils were analyzed.

RESULTS

Results showed a significant difference between the two countries indicating that lifetime and past year prevalence of deliberate self-harm were both 2.8 times higher in Belgian adolescents than in Dutch adolescents. Further analyses identified differences in the prevalence of factors associated with deliberate self-harm, with Belgian adolescents showing significant higher scores on anxiety, less problem-oriented coping and more common use of alcohol and soft drugs. Belgian adolescents were also at higher risk for the experience of several life events in the previous year and before that such as conflicts with peers, parents and partner, being bullied at school or exposure to suicidal behavior in family and friends. In addition, Belgian adolescents showed less communication with family or teachers about their problems and difficulties.

CONCLUSIONS

The results of the study suggest that the increased risk of deliberate self-harm among Belgian adolescents may be associated with an increased reporting of several important life events and with additional ineffective problem-solving such as less problem-oriented coping, more substance use and less communication about their problems. These results support the assumption that sociocultural aspects of nations can influence the risk of deliberate self-harm and are important to consider when developing prevention strategies.

Suicide by jumping and accessibility of bridges: results from a national survey in Switzerland

Rates of suicide by jumping show large regional differences. Barriers on bridges may prevent suicides but also may lead to a substitution of jumping site or method. The aim of our study was to compare suicide data from regions with and without suicide bridges and to estimate the effects on method and site substitution if bridges were to be secured. In a national survey, suicide data for the years 1990 to 2003 were collected. Regions with high rates of bridge suicides were identified and compared with regions with low rates, and the analysis revealed that only about one third of the individuals would be expected to jump from buildings or other structures if no bridge was available. The results suggest no method substitution for women. For men, a trend of a substituting jumping by overdosing in regions without suicide bridges was found. We conclude that restricted access to suicide bridges will not automatically lead suicidal individuals to choose another jumping site or suicide method. The results support the notion that securing bridges may save lives.

Risk factors for suicidality in Europe: results from the ESEMED study

BACKGROUND

Precise knowledge of the epidemiology of suicidality provides necessary information for designing prevention programs. The aims of the present study were to investigate the prevalence and correlates of suicidal ideas and attempts in the general population of Europe.

METHODS

The European Study on the Epidemiology of Mental Disorders (ESEMED) is a cross-sectional household survey carried out in a probability representative sample of non-institutionalised adults (aged 18 years or older) of six European countries (Belgium, France, Germany, Italy, the Netherlands and Spain). The Composite International Diagnostic Interview (CIDI 3.0) was administered to 21,425 individuals.

RESULTS

Lifetime prevalence of suicidal ideation was 7.8% and of suicidal attempts 1.3%. Being women, younger and divorced or widowed were associated with a higher prevalence of suicide ideation and attempts. Psychiatric diagnoses were strongly related to suicidality. Among them, major depressive episode (Rate ratio 2.9 for lifetime ideas and 4.8 for lifetime attempts), dysthymia (RR 2.0 and 1.6), GAD (RR 1.8 and 2.3 for lifetime), PTSD (RR 1.9 and 2.0) and alcohol dependence (RR 1.7 and 2.5) were the most important. Population attributable risks for lifetime suicidal attempt was 28% for major depression.

LIMITATIONS

Information about suicidal ideas and attempts was self reported, psychiatric diagnoses were made using fully structured lay interviews rather than clinician-administered interviews.

CONCLUSIONS

In spite of meaningful country variation in prevalence, risk factors for suicidality are consistent in the European countries. Population prevention programmes should focus on early diagnosis and treatment of major depression and alcohol abuse and in those individuals with recent appearance of suicidal ideas.

Perceived reasons for living at index hospitalization and future suicide attempt

It is unclear why certain individuals choose not to engage in suicidal behavior. Although important, protective factors against suicidal behavior have seldom been studied. The Reasons for Living Inventory is a measure of putative protective factors that is inversely related to a history of suicide attempts, but its predictive utility remains relatively untested. This study sought to determine whether the Reasons for Living Inventory predicts future suicide attempts over a 2-year period. Depressed inpatients were assessed for reasons for living and were followed for 2 years. Follow-up interviews took place at 3 months, 1 year, and 2 years after discharge from the index hospitalization. Survival analysis indicates a high score on the Reasons for Living Inventory predicted fewer future suicide attempts within a 2-year period in women but not in men. Perceived reasons for living serve as protective factors against suicide attempt in women and not in men.

Ethnocultural aspects of suicide in young people: a systematic literature review part 1: Rates and methods of youth suicide

The study of ethnocultural aspects of suicidal behaviour is, at the moment, still a neglected area. The relatively few studies available are mainly on adults; young people usually are not examined separately. The authors reviewed 82 publications on youth suicide that have addressed, to different degrees, the ethnicity/culture of the population studied. Following a description of the main characteristics shared by these researches (e.g., predominance of studies on Blacks, Whites, and Hispanics; lack of qualitative methodology, etc.), the rates and methods of youth suicide, from a cross-cultural perspective are discussed.

Suicide in bipolar disorder: Risks and management

Bipolar disorders are prevalent, often severe, and disabling illnesses with elevated lethality largely due to suicide. Suicide rates average approximately 1% annually, or perhaps 60 times higher than the international population rate of 0.015% annually. Suicidal acts typically occur early in bipolar disorders and in association with severe depressive or mixed states. The high lethality of suicidal acts in bipolar disorders is suggested by a much lower ratio of attempts:suicide (approximately 3:1) than in the general population (approximately 30:1). Risk factors can help to identify patients at increased suicidal risk, but ongoing clinical assessment is essential to limit risk. Empirical short-term interventions to manage acute suicidal risk include close clinical supervision, rapid hospitalization, and electroconvulsive therapy. Remarkably, however, evidence of the long-term effectiveness of most treatments against suicidal behavior is rare. A notable exception is lithium prophylaxis, which is associated with consistent evidence of major (approximately 80%), sustained relative reductions of risk of suicides and attempts, and lower lethality (increased attempts:suicide ratio). Such benefits are unproved for other treatments commonly used to treat bipolar disorder patients, including anticonvulsants, antipsychotics, antidepressants, and psychosocial interventions. Applying available knowledge systematically, with close and sustained clinical supervision, can enhance management of suicidal risk in bipolar disorders patients.

Emergency staff reactions to suicidal and self-harming patients

Staff in the emergency departments of hospitals are reported as being negative or ambivalent toward suicidal or self-harming individuals. According to the literature, these patients are subjected to stigmatization and lack of empathy. This phenomenon has been linked to a decreased quality of care offered to these individuals and to missing an important opportunity to prevent further suicidal behavior or repetition of deliberate self-harm. Also, protocols, proper guidelines and education for the emergency staff call for a revision and an implementation. In this paper, evidence suggesting staff attitudes toward suicidal and self-harming patients is reviewed. An overview of related issues such as clinical judgment, the use of scales and nurses' role is also included in this report.

The prevalence of suicidal phenomena in adolescents: a systematic review of population-based studies

The results of a systematic review of the international literature on the prevalence of suicidal phenomena in adolescents, including the influence of survey method, gender, and ethnicity are reported. The literature was searched using six electronic databases to identify all population-based studies of self-reported suicidal phenomena; 128 studies were included, comprising 513,188 adolescents. The mean proportion of adolescents reporting they had attempted suicide at some point in their lives was 9.7% (95% CI, 8.5-10.9), and 29.9% (95% CI, 26.1-33.8) of adolescents said they had thought about suicide at some point. Females were significantly more likely than males to report most suicidal phenomena. A lower prevalence of some suicidal phenomena was found for Asian populations. The prevalence of suicidal phenomena varied depending on the terminology used and tended to be higher in studies employing anonymous questionnaires than in studies employing non-anonymous methods (questionnaires or interviews), although most of these differences were not statistically significant.

Parasuicide in a low-income country: results from three-year hospital surveillance in Nicaragua

AIMS

A study was undertaken to assess the incidence of parasuicide in Nicaragua, to identify groups at risk, and to describe the characteristics of parasuicides, such as methods used and seasonal and diurnal patterns.

METHOD

All hospital-admitted parasuicide cases in the area of Leon, Nicaragua, were assessed over a three-year period using standardized instruments.

RESULTS

Two hundred and thirty-three parasuicide cases were identified in the catchment area giving a parasuicide rate of 66.3/100,000 inhabitants per year based on the population 10 years and older. Corresponding figure for 15 years and older was 71.3. A majority were females (68.8%), who were significantly younger than the males (mean 20.8 years vs. mean 24.6 years). The highest rates were found in the age group 15-19 years with a female rate three times higher than the male rate (302.9 vs. 98.9). Pesticides, a highly lethal substance, were used as method in 19.1% of the attempts. Consistent seasonal variation with peaks in May-June and September-October were found over the years. Among parasuicide cases, 46.5% had been in contact with the healthcare system within 6 months before attempting suicide.

CONCLUSIONS

Parasuicides represent a significant health problem among young people in Nicaragua. Preventive efforts should be directed especially towards the life situation for young girls, limitation of availability of suicide means, increased awareness in schools concerning suicidal problems, as well as improved management of patients with mental health problems within primary healthcare.

Risky behaviors and factors associated with suicide attempt in adolescents

The objective of this study was to identify the behavior risk factors associated with suicide attempt in adolescents and to determine gender-specific patterns of risk factors. In 2001, the Center for Disease Control and Prevention (CDC) conducted National Youth Risk Behavior Survey for 13,601 high school students in the U.S. Data were analyzed with logistic regressions to identify the risk behaviors. New significant risk factors (being offered illegal drugs at school, being abused by a boyfriend/girlfriend, gender, and ethnicity) were identified for suicidal attempt in adolescents. Patterns of risk behaviors differed among male and female groups. Several new risk behaviors associated with suicide attempt in adolescents were identified. There were notable differences in risk behaviors between two gender groups, especially in the area of depression. These findings could have potentially important implications for preventing adolescent suicide attempts.

Suizidsterblichkeit unter T�rkinnen und T�rken in Deutschland

BACKGROUND

Suicide mortality is usually higher among men than among women. In socially disadvantaged groups, this relationship can be reversed. We investigated whether this is the case among Turkish migrants in Germany.

MATERIAL AND METHODS

We calculated age- and sex-specific suicide rates for Turkish nationals residing in (West) Germany (1186 suicides) and for Germans aged below 65 years based on death registration data covering the period 1980-1997.

RESULTS

Age-adjusted suicide rates among Turks were lower than among Germans (relative risk 0.3). Among Turkish girls and young women under 18 years, however, the relative risk compared to Germans was 1.8 (95% confidence interval 1.4-2.3). The male-to-female ratio in this age group was 3.2 among Germans and 0.6 among Turks.

DISCUSSION

Overall, Turks living in Germany have a lower suicide mortality than Germans. Possible explanations include a high level of social coherence in the Turkish community and religious prohibitions. The high suicide rate among Turkish girls and young women could indicate the presence of social or cultural conflict situations.

Trends in adolescent suicide mortality in the WHO European Region

Trends in adolescent suicide rates (15-19 years) from 1979 to 1996 were compared with suicide trends in individuals of 20 years and over in 30 countries and with trends in rates of deaths due to undetermined causes in adolescents in 17 countries of the WHO European Region. In 21 of the 30 studied countries, male adolescent suicide rates increased during the study period (highest increases in Belarus, Kazakstan and Ireland) accompanied by far less increases or decreases in suicide rates of males of 20 years and over. Part of the observed increases in Sweden, Ireland and Greece can be attributed to improved suicide statistics, while increases in Finland, Belgium, Bulgaria and the United Kingdom can be even higher due to the rising classification of deaths as "undetermined". In Portugal, decreasing suicide trends seem to be misinterpreted by ignoring the vast increases in rates of undetermined deaths. Female adolescent suicide rates rose less markedly than in males in 18 countries, with the exception of strong increases in Norway, Ireland. Increases in female adolescent suicide rates were marginally affected by changes in classification practices and were accompanied primarily by declining suicide rates in females of 20 years and over.

Parasuizide bei Kindern und Jugendlichen

Zusammenfassung. In dieser Übersichtsarbeit werden spezifische Aspekte parasuizidalen Verhaltens bei Kindern und Jugendlichen dargestellt. Bedeutsame Risikofaktoren sind psychische Störungen der Minderjährigen sowie ein niedriges Funktionsniveau ihrer Familien, aber auch diverse andere personbezogene und psychosoziale Variablen sind überzufällig häufig mit Parasuiziden assoziiert. Eine kleine Untergruppe der Kinder und Jugendlichen zeigt wiederholt auftretendes parasuizidales Verhalten. Diagnostische und therapeutische Implikationen der dargestellten wissenschaftlichen Befunde werden erörtet.

Jugendliche in stationärer psychiatrischer Behandlung: Parasuizidale Symptome und psychische Störungen

Zusammenfassung. Psychische Störungen zählen zu den wichtigsten Ursachen für Parasuizide und Suizide. Dies gilt für das Erwachsenenalter und mit gewissen Abstrichen auch für das Jugendalter. Die häufigsten psychischen Störungen im Zusammenhang mit Suizidalität im Jugendalter sind akute Belastungsreaktionen, affektive Störungen, Substanzmissbrauch sowie Borderline-Syndrome und andere beginnende Persönlichkeitsstörungen. Essstörungen und Schizophrenien sind dagegen im Jugendalter noch nicht mit erhöhten Parasuiziden verknüpft. Anhand einer Gesamtstichprobe von 537 konsekutiv aufgenommenen und nach ICD-10 diagnostizierten stationär behandelten jugendpsychiatrischen Patienten konnten 163 mit parasuizidalen Symptomen bei Aufnahme ermittelt werden, die etwa zur Hälfte aus parasuizidalen Gedanken und parasuizidalen Handlungen bestanden. Der Anteil parasuizidaler Jugendlicher auf der Aufnahmestation lag bei etwa 66 %, auf der Therapiestation (Rottmannshöhe) bei etwa 30 %. Dies spricht für die Relevanz von Selektionsfaktoren bei Häufigkeits- und vermutlich auch Schweregradangaben von Suizidalität im stationären jugendpsychiatrischen Bereich.

Presentations by youth to Auckland emergency departments following a suicide attempt

The objective of this study was to describe the population of European youth (15-24 years) presenting to emergency departments (EDs) at one of the three Auckland public hospitals following attempted suicide; and to identify factors associated with presentations to EDs by these youth. A 1-year medical record review was undertaken. A total of 212 presentations (196 individuals) occurred during the surveillance; alcohol was present for 29%. Attempts involving alcohol were more likely to occur at weekends (P < 0.01); involve cutting and piercing (P < 0.05); be undertaken by employed people (P < 0.05), and be undertaken by those not residing with family (P < 0.01). Two groups of particular concern were identified: those who involved alcohol in their attempt; and those who represented during the study period following multiple suicide attempts. These findings have implications for immediate care within an ED setting, and long-term follow-up healthcare options for distressed young people.

Informant-specific correlates of suicidal behavior in a community survey of 12- to 14-year-olds

OBJECTIVES

To arrive at a better estimation of informant-specific correlates of suicidal behavior in young adolescents and to see how agreements and discrepancies between child and parent informants can contribute to the development of research and interventions.

METHOD

The weighted sample from the Quebec Child Mental Health Survey conducted in 1992 included 825 adolescents, aged 12 to 14 years, and their parents. The adolescent and one parent were questioned by two different interviewers. The response rate was 80.3%. Three categories of independent variables were assessed: adolescent, family, and socioeconomic characteristics. Logistic regression models were based on the adolescent and parent informant reports.

RESULTS

Parents identified 6 of the 59 adolescents having reported suicidal ideation and 2 of the 36 adolescents having reported suicide attempts. Two informant-specific models of correlates of suicidal behavior were found. The adolescent model included internalizing and externalizing mental disorders, family stressful events, and parent-adolescent relationship difficulties, while the parent model included perceiving a need for help for the adolescent, parent's depressive disorders, and parent-adolescent relationship difficulties.

CONCLUSION

The study shows the relevance of considering informant-specific correlates of suicidal behavior in the development of research and interventions targeting youths suicidal behavior.

Randomized trial of group therapy for repeated deliberate self-harm in adolescents

OBJECTIVE

To compare group therapy with routine care in adolescents who had deliberately harmed themselves on at least two occasions within a year.

METHOD

Single-blind pilot study with two randomized parallel groups that took place in Manchester, England. Sixty-three adolescents aged 12 through 16 years were randomly assigned to group therapy and routine care or routine care alone. Outcome data on suicide attempts were obtained without knowledge of treatment allocation on all randomized cases (62/63 by direct interview) on average 29 weeks later. The primary outcomes were depression and suicidal behavior.

RESULTS

In intention-to-treat analyses, adolescents who had group therapy were less likely to be "repeaters" at the end of the study (i.e., to have repeated deliberate self-harm on two or more further occasions) than adolescents who had routine care (2/32 versus 10/31; odds ratio 6.3), but the confidence intervals for this ratio were wide (95% confidence interval 1.4 to 28.7). They were also less likely to use routine care, had better school attendance, and had a lower rate of behavioral disorder than adolescents given routine care alone. The interventions did not differ, however, in their effects on depression or global outcome.

CONCLUSIONS

Group therapy shows promise as a treatment for adolescents who repeatedly harm themselves, but larger studies are required to assess more accurately the efficacy of this intervention.

Suicidal behaviour and family factors among Dutch and Slovenian high school students: a comparison

OBJECTIVE

East European countries have much higher suicide rates than West European countries. Whether this also applies for suicidal ideation and suicide attempts is not known. In addition, the role of family factors in relation to suicidal behaviour has not been investigated in East European countries.

METHOD

Two representative samples of 19,250 Dutch and 4706 Slovenian high school students were compared on the basis of self-report data.

RESULTS

Slovenian students report more suicidal behaviour (ideation and attempts) as well as more unfavourable family circumstances than Dutch students. This applies especially to the death of parent(s), the number of changes in their living situation, and to conflicts between or with parents.

CONCLUSION

A relation between family characteristics and suicidal behaviour is established in both samples, but proved to be strongest in Slovenian girls. Complicated cultural and socioeconomic differences between the two countries may account for the reported differences.

Characteristics of suicide among children and adolescents in Budapest

BACKGROUND

In Europe, the suicide rate among children and adolescents is the highest in Hungary. In the young age group (10-14 and 15-19 years), the suicide mortality rate had not showed a decrease.

METHODS

This study examined suicide cases committed by children and adolescents highlighted from the extraordinary death cases in Budapest between 1994 and 1998. The 72 suicide cases, which included 59 males and 13 females, were processed by sex, age, method and time of commitment, and distribution by districts.

RESULTS

Leaping off high places or hanging was the highest frequency among the methods of commitment. Accurate data about the frequency, type, time and location of death cases are indispensable to decrease the number of children's and adolescents' suicides.

CONCLUSIONS

Studies of epidemiology and risk factors may provide a basis of development of a specific suicide prevention programme including educational, health and welfare elements.

Attempted and completed suicide in older subjects: results from the WHO/EURO Multicentre Study of Suicidal Behaviour

OBJECTIVE

The authors present an analysis of findings for the 65 years and over age group from the WHO/EURO Multicentre Study of Suicidal Behaviour (1989-93).

METHODS

Multinational data on non-fatal suicidal behaviour is derived from 1518 subjects in 16 European centres. Local district data on suicide were available from 10 of the collaborating centres.

RESULTS

Stockholm (Sweden), Pontoise (France) and Oxford (UK) had the highest suicide attempts rates. In most centres, the majority of elderly who attempted suicide were widow(er)s, often living alone, who used predominantly voluntary drug ingestion. Non-fatal suicidal behaviour decreased with increasing age, whereas suicide rates rose. The ratio between fatal and non-fatal behaviours was 1:2, that for males/females almost 1:1. In the years considered, substantial stability in suicide and attempted suicide rates was observed. As their age increased, suicidal subjects displayed only a limited tendency to repeat self-destructive acts. Moreover, there was little correlation between attempted suicide and suicide rates, which carries different clinical implications for non-fatal suicidal behaviour in the elderly compared with younger subjects in the same WHO/EURO study.

Deliberate self-harm in adolescents in Oxford, 1985-1995

Deliberate self-harm (DSH) has been one of the major health problems of adolescents in the U.K. for many years. Any changes in rates of DSH or the demographic characteristics of the patient population are likely to have important implications for clinical services and for future suicidal behaviour. Following a decline in rates in the late 1970s and mid 1980s, there were signs in the late 1980s that rates were beginning to increase again. We have used data collected by the Oxford Monitoring System for Attempted Suicide on the basis of patients presenting to the general hospital in Oxford to review trends in DSH in under 20-year-olds between 1985 and 1995. There was a substantial increase in the numbers of teenage DSH patients during the 11-year study period, with an increase between 1985-1986 and 1994-1995 of 27.7% in males, 28.3% in females, and 28.1% overall. There were no demographic changes within the catchment area to explain a change of this size. As rates of repetition of DSH also increased in both sexes during the study period the overall number of episodes of DSH rose even more between 1985-1986 and 1994-1995 (+56.9% in males, +46.3% in females, and +49.4% overall). As in previous studies the majority of adolescents had interpersonal problems and/or difficulties with studying or employment. Self-poisoning with paracetamol and paracetamol compounds became increasingly common such that by 1995 these were used in almost two-thirds of overdoses. The recent increase in DSH in adolescents has important implications for general hospital and adolescent psychiatric services. The greater frequency of repetition of DSH may herald increased future suicide rates. The case for restricting the amount of paracetamol available is overwhelming. Evaluative trials of specific interventions following adolescent DSH are urgently required.

Why has suicide increased in young males?

Several countries in the Western hemisphere have experienced a marked increase in suicide rates in young males in recent years. This article considers this phenomenon largely from the perspective of the United Kingdom, where rates of suicide in 15-24-year-old males nearly doubled in just over a decade. The possible reasons for this are considered, particularly in the context of relative stability of suicide rates in young females.