Suicide Behaviour in a Clinical Sample of Children and Adolescents in New Zealand

Treating young people at high risk for suicide has been identified as a priority area for development in mental health services. This study aimed to establish the prevalence of suicide ideation and suicidal behaviour in a child and adolescent mental health service and examine if children and adolescents with deliberate self-harm (DSH) were different from those who had not engaged in DSH in terms of individual and family risk factors. A file audit was conducted of 100 clients in a South Auckland service. Just under half of the clients (48%, N = 48) had engaged in DSH at the time of initial assessment, a further 16% (N = 16) had expressed suicide ideation without DSH. Children and adolescents who had engaged in DSH and/or had suicide ideation were older, had more maternal substance abuse, more family history of offending, were more likely to have been sexually abused, used more substances themselves, and were more likely to have previous episodes of DSH. ********** Suicide is of major concern in New Zealand. In 2000, the most recent year for which standardised statistics are available, 96 young people between the ages of 15 and 24 years died by suicide, of whom 81 were young men. New Zealand continues to have the highest rate of male youth suicide deaths among OECD countries (18.1 per 100,000 population) and our young women are defying international trends with increasing rates of suicide in recent years (New Zealand Health Information Service, 2003). In addition, more than fifteen hundred adolescents per year receive hospital treatment following deliberate self-harm (DSH) (New Zealand Health Information Service, 2001, 2003). Up to 90% of adolescents engaging in DSH do not present to hospital following deliberate self-harm (Hawton, Rodham, Evans, & Weatherall, 2002), or present to General Practitioners (GPs), so official statistics are likely to significantly underestimate the actual rates of DSH. Many young people consider suicide at some point in their lives, a significantly smaller number make suicide attempts, and even fewer die as a result. DSH may occur in the presence of suicidal thoughts, it may occur with or without the intention to die, or it can occur independently of suicidal thoughts. The term "self mutilation" is often used to describe the latter behaviour (Sakinofsky, 2000), and is frequently characterised by cutting behaviour, although burning is also common. Such acts of DSH are thought to reduce anger, tension or dissociative numbness. Regardless of intention or function, DSH is associated with increased risk of suicide, and for this reason, authorities such as the World Health Organisation (WHO) and others include any form of DSH as suicidal behaviour (Cantor & Neulinger, 2000; Hawton & van Heeringen, 2000). A further reason for considering any DSH as being within the suicide behaviours spectrum is that establishing the motives or intent for DSH is often difficult, regardless of the method used by the child or adolescent (Hawton & van Heeringen, 2000). Adolescents who engage in DSH often appear to be ambivalent about suicide or may report a number of reasons for engaging in DSH (Rodham, Hawton, & Evans, 2004). Fluctuating cognitive states can make it difficult to access clear information from adolescents about their suicide behaviour and intent, particularly when seeking this information retrospectively. Young people are known to underestimate risks (Wagner, Wong, & Jobes, 2002) and habitually engage in behaviours that carry high risk. Thus, a child or adolescent may not intend to die but selects a method that is lethal, or conversely, they may intend to die but select a method that is relatively benign (Bagley & Ramsay, 1997). However, it appears that once they actually engage in DSH behaviour, they cross some attitudinal and behavioural line, and are more likely to engage in this behaviour again (Goldston et al., 1999). Epidemiological studies in New Zealand, and overseas, have identified risk factors associated with suicide behaviour among children and adolescents in the general population across biological, demographic, cognitive, environmental and mental health domains. …