Serious suicide attempts in young people : a case control study

Abstract

Risk factors for serious suicide attempts among young people were examined in a case control study in which a consecutive series of 129 young people aged 13 to 24 years who made serious suicide attempts was compared with 153 control subjects selected randomly from the community.

Review of the literature suggested five domains of risk factors were likely to contribute to suicide attempt risk: social and demographic factors; family background and childhood experiences; personality traits; psychiatric disorder; environmental factors, including, particularly, life events.

Case control analyses confirmed the contribution of these risk factor domains to suicide attempt risk and suggested that those at increased risk of serious suicide attempt included: 1. Individuals who lacked formal educational qualifications and were of low socio-economic status. 2. Young people who reported higher rates of childhood and family adversity including childhood sexual abuse, poor parental relationships during childhood and parental alcohol problems during childhood. 3. Individuals with significantly higher scores on measures of neuroticism and hopelessness. 4. Individuals characterised by the presence of psychiatric morbidity, including, in particular, affective disorders and substance use disorders, within the month prior to the suicide attempt. 5. Those characterised by higher rates of reported life events including, particularly, interpersonal or legal problems.

These findings were established using data gathered from self reports and reports provided by a parallel informant (a significant other) thus reducing risks that results could be attributed to recall bias.

In general, the findings of this study suggest a life course model of suicide attempt risk in which the aetiology of suicide attempts is multicausal and reflects an accumulation of adverse factors and influences including: social disadvantage; childhood and family adversity; personality difficulties; psychiatric disorders and exposure to adverse life events. Of those making suicide attempts, 65.9% had risk factors from four or more of the five risk factor domains and it was estimated that those reporting a total of five or more risk factors had odds of serious suicide attempt which were over 120 times higher than those with an absence of risk factors. The findings from statistical analysis of risk factor data were generally consistent with the themes evident from qualitative examination of case history material.

The major contribution of this study is to provide an account of the ways in which multiple risk factors combine over an individual's life course to influence risks of serious suicide attempt. Parallel to these findings there are a number of possible opportunities for interventions to reduce suicide attempt risk in young people. These intervention opportunities include: macro-social approaches including reduction in social inequities, reduction of unemployment and restriction of access to methods of suicide; targeted early intervention and family support programmes aimed at improving the life circumstances of those at high risk of psychosocial disorders; school based programmes aimed at fostering good mental health among young people, and programmes to educate teachers to recognise and refer students at risk for suicide; improved recognition and treatment of adolescent mental health problems, particularly of affective disorders and substance use disorders.