Clinical Review ABC of adolescence

Suicide and deliberate self harm in young people

BMJ 2005; 330 doi: http://dx.doi.org/10.1136/bmj.330.7496.891 (Published 14 April 2005) Cite this as: BMJ 2005;330:891
  1. Keith Hawton,
  2. Anthony James

    Introduction

    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 and undetermined deaths in England and Wales in 15-19 year olds and 20-24 year olds between 1968 and 2000. Data source: Office for National Statistics. Twentieth century mortality: 100 years of mortality data in England and Wales by age, sex, year and underlying cause. CD Rom. London: ONS, 2003.

    Suicide

    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.

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    Possible reasons for rise in male suicide rates in United Kingdom

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    Common characteristics of adolescents who die by suicide

    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.

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    Common expressions of parental grief after suicide by …

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