Research report
Suicidal ideation and suicide attempts among child and adolescent psychiatric inpatients in Finland

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Abstract

Background: The aim was to study the prevalence of, and factors associated with, suicidal ideation and suicide attempts among child and adolescent inpatients during hospital treatment. Methods: The target group included all the child and adolescent psychiatric inpatients (n=504) in Finland on a chosen day. Suicidality was determined by the psychiatrist responsible for the inpatient treatment, using a questionnaire also exploring demographic, diagnostic, and treatment characteristics, as well as traumatic events of the patient. Results: The rate of suicidal ideation was 37.6%, and suicide attempts 10.8%. The factors independently associated with suicidal ideation in multivariate analysis were the following: being affected by open adult sexual behaviour (OR 3.2), having depression (OR 2.5) or conduct disorder (OR 2.4) diagnosis, and manifesting violent acts (OR 2.4). The factors independently associated with suicide attempts were: manifesting violent acts (OR 8.1), having depression diagnosis (OR 5.3), being affected by open adult sexual behaviour (OR 4.9), involuntary treatment (OR 4.7), and being of the female sex (OR 3.7). Suicidal ideation was particularly prevalent among boy patients having conduct disorders, manifesting violent acts, and belonging to the age group under 13 years old. Suicide attempts were particularly prevalent among depressive adolescent girl patients. Limitations: Suicidality was based solely on the clinician’s evaluation. Conclusions: Suicidal ideation and suicide attempts are common among child and adolescent psychiatric inpatients. Particular attention should be directed to inpatients who manifest violent acts or have depressive disorder.

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.

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