Research reportSuicidal ideation and suicide attempts among child and adolescent psychiatric inpatients in Finland
Introduction
There are several reasons why suicidality has great importance in child and adolescent inpatient psychiatry. Firstly, self-harm behaviour and suicidality is one of the major admission criteria for inpatient treatment. Secondly, previous studies have shown an increased suicide risk in child and adolescent psychiatric inpatients (Hawton et al., 1993, Kjelsberg et al., 1998). Thirdly, suicidal behaviour in child and adolescent units may be contagious, promoting suicidal behaviour among others warded in the same ward (Taiminen et al., 1998). Suicidal behaviours are often repetitive and place adolescents at increased risk for eventual suicide (Myers et al., 1991, Pfeffer et al., 1991).
The risk factors for suicidal behaviour among young people are multifactorial, complex and interrelated (Beautrais et al., 1996, Gröholt, 1999). Strong and consistent associations have been found between suicidal behaviour and parental psychopathology (Fergusson and Lynskey, 1995, Brent et al., 1996, Gould et al., 1996), poor inter-familial communication (Brent et al., 1994a), parental discord or separation (Andrews and Lewinsohn, 1992, Beautrais et al., 1996) and a history of past physical and/or sexual abuse (De Wilde et al., 1992, Garnefski et al., 1992, Silverman et al., 1996). A majority of young people who die by suicide or make a serious attempt have a recognisable psychiatric disorder at the time of their attempt, most commonly affective disorder, substance abuse or antisocial behaviour (Allebeck and Allgulander, 1990, Marttunen et al., 1991, Beautrais et al., 1996). The link between suicidal behaviour and depression is especially important because of the relatively high prevalence of depression. Although relatively few young people have a psychotic disorder, the risk of suicide has been reported to be very high amongst the relatively small number with these severe mental illnesses (Westermeyer et al., 1991). Young people with co-morbid psychiatric conditions have an increased risk of suicidal behaviour and the increased risk seems to be directly proportional to the number of co-morbid conditions (Marttunen et al., 1991, Lesage et al., 1994, Shaffer et al., 1996). Suicidal behaviour is often preceded by a stressful life event such as an interpersonal conflict, loss, or legal/disciplinary problems (Brent et al., 1993, Morano et al., 1993, Beautrais et al., 1997). These events may act as a precipitant for suicidal behaviour in an adolescent who often may have other underlying risk factors (Brent et al., 1993, Beautrais et al., 1997).
Children and adolescents warded in psychiatric hospitals usually have several of the risk factors mentioned above. They have serious psychiatric disorders/illnesses and they often have backgrounds with other hardships. However, there is a lack of nationwide studies on suicidality among child and adolescent psychiatric inpatients. The aim of the present study is to report the prevalence of suicidal ideation and suicide attempts among child and adolescent psychiatric inpatients during hospital treatment in Finland. Furthermore, the aim is to identify factors associated with suicidality among these inpatients. Our hypothesis was that the different demographic, diagnostic, treatment, and traumatic factors are differently associated with suicidal ideation and with suicide attempts.
Section snippets
Procedure
The study design was a cross-sectional epidemiological study. The study was carried out in January 2000. The psychiatrist responsible for the inpatient treatment was asked to fill in a questionnaire for every inpatient. The clinician estimated suicidality and made the other evaluations using all the information available about the patient, e.g. clinical assessments and records, and information on staff/patient interactions during the treatment, 24 h a day.
Subjects
The target group of the study included
Prevalence of suicidal ideation and suicide attempts
Suicidal ideas were reported at 27.3%, suicidal threats 10.4%, mild suicide attempts 5.6% and serious suicide attempts 5.2%. Table 2 shows the prevalence of suicidality during hospital treatment within different age groups separately among boys and girls. The prevalence of suicidal ideation was about the same for both sexes and somewhat higher within the age group under 13 years old than within the age group 13–18 years old. The prevalence of suicide attempts was highest among adolescent girl
Prevalence, age and sex
Almost half of the inpatients had suicidal ideation or had attempted suicide in the present study. This is in line with other adolescent inpatient studies (Larsson and Ivarsson, 1998). Suicide attempts were much more common within the older age group (13–18 years). Adolescent female inpatients, particularly, had a high level of suicide attempts. The frequency of suicide and suicide attempts increases sharply during adolescence (Aro et al., 1993, Schmidtke et al., 1996). Adolescence is a time of
Conclusions
The present study suggests that suicidal ideation and suicide attempts are common among child and adolescent psychiatric inpatients in Finland. Suicide attempts were more prevalent among adolescent girl patients, although suicidal ideation was also common among boy patients and in the younger age group. The strongest association with suicidality was found for violent acts. Of the different diagnostic groups, particular attention should be directed to patients with depressive disorders (more
Acknowledgements
The Emil Aaltonen Foundation, the Sigrid Juselius Foundation, and the Turku University Foundation supported this study.
References (53)
- et al.
Suicidal attempts among older adolescents: prevalence and co-occurrence with psychiatric symptoms
J. Am. Acad. Child Adolesc. Psychiatry
(1992) - et al.
Risk factors and life events in serious suicide attempts among youths aged 13 through 24 years
J. Am. Acad. Child Adolesc. Psychiatry
(1996) - et al.
Precipitating factors and life events in serious suicide attempts among youths aged 13 through 24 years
J. Am. Acad. Child Adolesc. Psychiatry
(1997) - et al.
Personality disorder, personality traits, impulsive violence, and completed suicide in adolescents
J. Am. Acad. Child Adolesc. Psychiatry
(1994) - et al.
A follow-up study of hospitalized suicidal children
J. Am. Acad. Child Adolesc. Psychiatry
(1982) - et al.
Childhood circumstance, adolescent adjustment, and suicide attempts in a New Zealand birth cohort
J. Am. Acad. Child Adolesc. Psychiatry
(1995) - et al.
Child sexual abuse and emotional and behavioral problems in adolescence: gender differences
J. Am. Acad. Child Adolesc. Psychiatry
(1997) - et al.
Suicidal adolescents after hospitalisation: parent and family impact on treatment follow-through
J. Am. Acad. Child Adolesc. Psychiatry
(1997) - et al.
The 3-year longitudinal course of suicidality and predictive factors for subsequent suicidality in youths with major depressive disorders
J. Am. Acad. Child Adolesc. Psychiatry
(1991) Self destructive behavior in children and adolescents
Psychiatr. Clin. North Am.
(1985)
Suicidal children grow up: demographic and clinical risk factors for adolescent suicide attempts
J. Am. Acad. Child Adolesc. Psychiatry
Suicidal behavior in adolescent psychiatric inpatients
J. Am. Acad. Child Adolesc. Psychiatry
Suicidal behavior in latency-age psychiatric inpatients: a replication and cross validation
J. Am. Acad. Child Adolesc. Psychiatry
The long-term sequelae of child and adolescent abuse: a longitudinal community study
Child Abuse Neglect
Suicidal behavior among adolescents
J. Affect. Disord.
Contagion of deliberate self-harm among adolescent inpatients
J. Am. Acad. Child Adolesc. Psychiatry
Categorical Data Analysis
Suicide among young men: psychiatric illness, deviant behaviour, and substance abuse
Acta Psychiatr. Scand.
Adolescent development and suicide
Suicide Life-Threat. Behav.
Further measures of the psychometric properties of the Children’s Global Assessment Scale (CGAS)
Arch. Gen. Psychiatry
Risk factors for adolescent suicide: a comparison of adolescent suicide victims with suicidal inpatients
Arch. Gen. Psychiatry
Stressful life events, psychopathology, and adolescent suicide: a case control study
Suicide Life-Threat. Behav.
Familial risk factors for adolescent suicide: a case-control study
Acta Psychiatr. Scand.
A controlled family study of adolescent suicide victims
Arch. Gen. Psychiatry
The relationship between adolescent suicidal behaviour and life events in childhood and adolescence
Am. J. Psychiatry
A population based survey of the characteristics of high school students with and without a history of suicidal behaviour
Acta Psychiatr. Scand.
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