CHAPTER 12
Suicide and Deliberate Self-harm
Completed suicide
Epidemiology
Completed suicide is very rare under the age of 12 and becomes pro-
gressively more common thereafter, with peak rates in the elderly. In
the United Kingdom, there are roughly five suicides (including definite
suicides and the more common ‘undetermined deaths’, which are very
often suicides) per million children aged 5–14 per year. The rate rises to
roughly 45 suicides per million for 15–19-year-olds, which is still substan-
tially lower than rates in older age bands. There is a male excess at all ages,
partly reflecting the male predilection for violent and more lethal methods
(hanging, shooting, electrocution), as opposed to the female predilection
for poisoning (mostly with analgesics and antidepressants). Rates vary by
country and ethnicity, for example, being higher in the USA, where the
rate in Whites is about 50% higher than in Blacks. Since the mid-1990s,
suicide rates in the UK and the USA have declined by around 20% in
both males and females. Whether this welcome trend is due to improved
treatment of teenage depression, as some have suggested, is far from
certain.
What protects younger children?
Though children commonly believe that death is reversible, the claim
that it is this belief that inhibits suicidal ideas or acts seems implausible.
More plausible protective factors include: the relative rarity of severe
depressive disorders and substance abuse problems before puberty; the
lack of sufficient cognitive maturity to experience profound hopelessness
or plan a successful suicide; restricted access to lethal methods; and the
presence of a supportive network of relationships at home or school.
Child and Adolescent Psychiatry, Third Edition. Robert Goodman and Stephen Scott.
©c2012 Robert Goodman and Stephen Scott. Published 2012 by John Wiley & Sons, Ltd.
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