Change in prevalence of self-harm from 2002 to 2018 among Norwegian adolescents.

BACKGROUND: Self-harm is prevalent among adolescents and associated with mental health problems and negative life-events. Few studies have examined changes in its prevalence related to these factors. This study explored whether changes in prevalence of self-harm among adolescents had occurred, and to what extent changes in associated factors may have contributed. METHODS: Two cross-sectional school-based surveys among adolescents (grades 8-10) in Norway were conducted in 2002 (N = 5842) and in 2017/18 (N = 29 063). Past year prevalence of self-harm and identical variables on risk factors was analyzed in hierarchical logistic regression to examine whether and to what extent changes in self-harm correlates could explain periodical change in prevalence of self-harm. RESULTS: An increase from 4.1% to 16.2% in self-harm prevalence was observed from 2002 to 2017/18. The increase was relatively larger among girls compared to boys and among 8th graders compared to 10th graders. Among the assessed risk factors for self-harm, depressive symptoms increased, while anti-social behavior, exposure to violent acts and drinking to intoxication decreased. The increase in depressive symptoms contributed to explain increase in self-harm. This contribution was outweighed by the decrease in other risk factors. CONCLUSIONS: Self-harm prevalence increased 4-fold among Norwegian adolescents over a 15-year period. While exposure to several risk factors for self-harm changed substantially in this period, these risk factors could in sum not explain any of the increase in self-harm.

Long term effectiveness of dialectical behavior therapy versus enhanced usual care for adolescents with self-harming and suicidal behavior.

BACKGROUND: Knowledge is lacking on the long-term outcomes of treatment for adolescents with repetitive suicidal and self-harming behavior. Furthermore, the pathways through which treatment effects may operate are poorly understood. Our aims were to investigate enduring treatment effects of dialectical behavior therapy adapted for adolescents (DBT-A) compared to enhanced usual care (EUC) through a prospective 3-year follow-up and to analyze possible mediators of treatment effects. METHODS: Interview and self-report data covering the follow-up interval were collected from 92% of the adolescents who participated in the original randomized trial. TRIAL REGISTRATION NUMBER: NCT01593202 (www.ClinicalTrials.gov). RESULTS: At the 3-year follow-up DBT-A remained superior to EUC in reducing the frequency of self-harm, whereas for suicidal ideation, hopelessness and depressive and borderline symptoms and global level of functioning there were no inter-group differences, with no sign of symptom relapse in either of the participant groups. A substantial proportion (70.8%) of the effect of DBT-A on self-harm frequency over the long-term was mediated through a reduction in participants' experience of hopelessness during the trial treatment phase. Receiving more than 3 months follow-up treatment after completion of the trial treatment was associated with further enhanced outcomes in patients who had received DBT-A. CONCLUSIONS: There were on average no between-group differences at the 3-year follow-up in clinical outcomes such as suicidal ideation, hopelessness, depressive and borderline symptoms. The significantly and consistently larger long-term reduction in self-harm behavior for adolescents having received DBT-A compared with enhanced usual care, however, suggests that DBT-A may be a favorable treatment alternative for adolescents with repetitive self-harming behavior.

The impact of ADHD symptoms and global impairment in childhood on working disability in mid-adulthood: a 28-year follow-up study using official disability pension records in a high-risk in-patient population.

BACKGROUND: Individuals with ADHD have been associated with more employment difficulties in early adulthood than healthy community controls. To examine whether this association is attributable specifically to disturbance of activity and attention (ADHD) or to psychopathology in general, we wanted to extend existing research by comparing the rate of mid-adulthood working disabilities for individuals diagnosed with ADHD as children with the rate for clinical controls diagnosed with either conduct disorder, emotional disorder or mixed disorder of conduct and emotions. METHODS: Former Norwegian child-psychiatric in-patients (n = 257) were followed up 17-39 years after hospitalization by record linkage to the Norwegian national registry of disability pension (DP) awards. Based on the hospital records, the patients were re-diagnosed according to ICD-10. Associations between the diagnoses, other baseline factors and subsequent DP were investigated using Kaplan-Meier survival analyses and logrank testing. RESULTS: At follow-up, 19% of the participants had received a DP award. In the logrank testing, ADHD was the only disorder associated with a subsequent DP, with 30% being disabled at follow-up (p = 0.01). Low psychosocial functioning (assessed by the Children's Global Assessment Scale) at admission uniquely predicted future DP (p = 0.04). CONCLUSIONS: ADHD in childhood was highly associated with later receiving a DP. Our finding of worse prognosis in ADHD compared with other internalizing and externalizing disorders in mid-adulthood supports the assumption of ADHD being specifically linked to working disability. Assessment of psychosocial functioning in addition to diagnostic features could enhance prediction of children who are most at risk of future disability.

The impact of ADHD and conduct disorder in childhood on adult delinquency: a 30 years follow-up study using official crime records.

BACKGROUND: Few longitudinal studies have explored lifetime criminality in adults with a childhood history of severe mental disorders. In the present study, we wanted to explore the association between adult delinquency and several different childhood diagnoses in an in-patient population. Of special interest was the impact of disturbance of activity and attention (ADHD) and mixed disorder of conduct and emotions on later delinquency, as these disorders have been variously associated with delinquent development. METHODS: Former Norwegian child psychiatric in-patients (n = 541) were followed up 19-41 years after hospitalization by record linkage to the National Register of Criminality. On the basis of the hospital records, the patients were re-diagnosed according to ICD-10. The association between diagnoses and other baseline factors and later delinquency were investigated using univariate and multivariate Cox regression analyses. RESULTS: At follow-up, 24% of the participants had been convicted of criminal activity. In the multivariate Cox regression analysis, conduct disorder (RR = 2.0, 95%CI = 1.2-3.4) and hyperkinetic conduct disorder (RR = 2.7, 95% CI = 1.6-4.4) significantly increased the risk of future criminal behaviour. Pervasive developmental disorder (RR = 0.4, 95%CI = 0.2-0.9) and mental retardation (RR = 0.4, 95%CI = 0.3-0.8) reduced the risk for a criminal act. Male gender (RR = 3.6, 95%CI = 2.1-6.1) and chronic family difficulties (RR = 1.3, 95% CI = 1.1-1.5) both predicted future criminality. CONCLUSIONS: Conduct disorder in childhood was highly associated with later delinquency both alone or in combination with hyperactivity, but less associated when combined with an emotional disorder. ADHD in childhood was no more associated with later delinquency than the rest of the disorders in the study population. Our finding strengthens the assumption that there is no direct association between ADHD and criminality.

Examination of the cut-off scores determined by the Ages and Stages Questionnaire in a population-based sample of 6 month-old Norwegian infants.

BACKGROUND: Few population-based samples have previously published performance on the Ages and Stages Questionnaire (ASQ), a recommended screening tool to detect infant developmental delay. The aim of the study was to investigate performance on the ASQ in a population-based sample of 6-month-old infants. METHODS: In this population-based questionnaire study from Oslo, Norway, the 30 item ASQ 6 month Questionnaire (N = 1053) were included, however without the pictograms, and compared to the Norwegian reference sample (N.ref) (N = 169) and to US cut-off values. Exclusion criteria were maternal non-Scandinavian ethnicity, infant age < 5.0 or > 7.0 months (corrected age), twins, and birth weight < 2.5 kg. Cut-off = 2.5 percentile (equivalent to mean minus 2 standard deviations). Pearson's Chi square and Mann-Whitney U were used to compare items and areas, respectively, with N.ref. RESULTS: The reported ASQ scores were lower on all but one of the 10 significantly different items, and in all areas except Personal social, compared to the N.ref sample. The estimated cut-off values for suspected developmental delay (Communication 25, Gross motor 15, Fine motor 18, Problem solving 25 and Personal social 20) were lower than the recommended American (US) values in all areas, and lower than the Norwegian values in two areas. Scores indicating need for further assessment were reached by 13.8% or 20.5% of the infants (missing items scored according to the US or the Norwegian manual), and by 33.8% or 30.3% of the infants using the recommended US or the Norwegian cut-off values, in this population-based sample. The Fine motor area demonstrated a large variability depending on the different cut-off and scoring possibilities. Both among the items excluding pictograms and the items that do not have pictograms, approximately every third item differed significantly compared to the N.ref sample. CONCLUSION: The psychomotor developmental scores were lower than in the reference samples in this study of ASQ 6 month Questionnaire; to our knowledge the first study to be both representative and comparatively large. Approximately every third child with birth weight above 2.5 kg, received scores suggesting further assessment using recommended ASQ cut-off scores.

[Drug treatment of depression in children and adolescents]. / Medikamentell behandling av depresjon hos barn og ungdom.

Antidepressants may increase suicidal behaviour in children and adolescents with depression, and should be used with great care. The article provides an overview of research that may guide the clinician when treating depression in young people. No medication should be given without a thorough evaluation of diagnoses and psychosocial problems. Psychoeducation and psychotherapy should be tried before medication is started. Fluoxetine is the first choice for depression. If it is not effective, a switch to another SSRI may prove effective. SSRIs are found to be more efficacious in adolescents than in children.

Understanding discrepancies in parent-child reporting of emotional and behavioural problems: Effects of relational and socio-demographic factors.

BACKGROUND: Discrepancies between parents and children in their assessment of children's mental health affect the evaluation of need for services and must be taken seriously. This article presents the differences between parents' and children's reports of the children's symptoms and social impairment, based on the results of the Strengths and Difficulties Questionnaire (SDQ). The interrelationship between relational aspects and socio-demographic factors with patterns of disagreement are explored. METHODS: Differences in the prevalence and means of SDQ symptom and impact scores were obtained from 8,154 primary school children, aged between 10 and 13 years, and their parents. Agreement between matched pairs was measured using Pearson's and Spearman's rho correlations. Socio-demographic variables, communication patterns and parental engagement were analysed as possible correlates of informant discrepancies using bivariate and multivariate logistic regression models. RESULTS: In general, although children reported more symptoms, they reported less impact of perceived difficulties than parents. The parents were more consistent in their evaluation of symptoms and impact than were the children. Exploration of highly discrepant subgroups showed that, when children reported the most symptoms and impact, qualitative aspects of the parent-child relationship and family structure seemed to be more powerful predictors of disagreement than were gender of the child and socio-demographic variables. When parents reported the most symptoms and impact, low parental educational level, low income and male gender of the child played an additional role. CONCLUSIONS: Our findings underline the importance of paying attention to child reports of emotional-behavioural difficulties, particularly when parents do not identify these problems. Considerations on what meaning parent-child discrepancy might have in the context of the parent-child relationship or the family's psychosocial status should be integrated in the overall understanding of the child's situation and subsequent recommendations.

Motor function may differentiate attention deficit hyperactivity disorder from early onset bipolar disorder.

BACKGROUND: Differentiating between bipolar spectrum disorder (BD) and attention deficit hyperactivity disorder (ADHD) in childhood and adolescence is difficult because the clinical presentation is influenced by ongoing neural development, causing considerable symptom overlap. Motor problems and neurological soft signs have been associated with ADHD for decades. Little is known about motor skills in BD. Here we assess the diagnostic accuracy of neuromotor deviations in differentiating ADHD from BD in clinical practice. We also investigate if these deviations exist in concurrent ADHD and BD, thus indicating true comorbidity METHODS: 64 patients 6-18 years (31 girls, 33 boys) fulfilling the diagnostic criteria of BD, ADHD combined subtype (ADHD-C) or comorbid BD and ADHD-C, were compared using an age-standardized neuromotor test; NUBU. Categorical variables were analyzed using cross table with two-tailed chi square test or Fisher's exact test when appropriate. Continuous variables were analyzed by Kruskal-Wallis test and, if significant, Mann-Whitney U test and ROC plots. RESULTS: The ADHD-C group and the comorbid ADHD-C and BD group both showed significantly more neurological soft signs (p less than 0.01) and lower mean static coordination percentile (p less than 0.01) than the BD group. The positive predictive value of NUBU in the diagnosis of ADHD-C with or without concurrent BD was 89% (80-95) for total soft signs and 87% (79-95) for static coordination below the 7.5 percentile. CONCLUSION: An age-standardized neuromotor test battery may promote diagnostic accuracy in differentiating ADHD from BD in clinical practice, and help evaluating whether symptoms of ADHD in children who have BD reflect symptom overlap or real comorbidity. This may have important implications for everyday diagnostic work.

Prevalence and characteristics of significant social anxiety in children aged 8-13 years: a Norwegian cross-sectional population study.

BACKGROUND: Social anxiety has been frequently studied in both population- and clinical-based adult and adolescent samples. Corresponding research in children is scarce and is dominated by clinical studies. The aim of the present population-based study was to examine the prevalence of significant social anxiety (SSA) in preadolescent children and compare their characteristics with those of children without SSA. The spectrum of social anxiety is explored by comparing children with different levels of social anxiety, as defined by 1-2 versus 3-5 social situations feared. METHOD: The sample consisted of 14,497 parents and their 3rd-7th grade children (8-13 years old) who participated in a health profile study, including questions covering DSM-IV criteria A-D for social anxiety disorder (SAD). Socio-demographic data, social and school functioning, somatic complaints, parent-child relationships, and use of health services were added to a logistic regression model to explore characteristics associated with children with, and without SSA. Associated emotional and behavioural problems were measured by the Strengths and Difficulties Questionnaire (SDQ) using parent and self-report. RESULTS: Parents described 2.3% of all children as significantly socially anxious and 0.9% feared at least three social situations. The majority of children with SSA managed their everyday life well. However, compared with children without SSA, children with SSA struggled more often in different areas of life and showed a significantly higher prevalence of associated emotional and behavioural symptoms. Our findings also support the notion of social anxiety as a spectrum concept. CONCLUSIONS: Social anxiety problems start in childhood and can be impairing, even in non-clinical populations and in reasonably young age groups. Increased awareness of different aspects of social anxiety is needed to identify children who are at risk and to devise appropriate interventions to improve the immediate and long-term outcome.

Prognosis after adolescent suicide attempt: mental health, psychiatric treatment, and suicide attempts in a nine-year follow-up study.

The prevalence of mental health and suicidal behavior was examined 8 to 10 years after an adolescent suicide attempt. Of 71 persons, 79% had at least one psychiatric disorder (mean 1.7) at follow-up, most commonly depression (46%), personality disorder (46%), and anxiety disorder (42%). The stability of diagnoses was moderate. The suicide attempters had received a substantial amount of treatment. One third had received inpatient treatment, and 78% psychiatric treatment, despite low compliance shortly after the index suicide attempt. At follow-up, repeated suicide attempts were found in 44% of the sample, and half of those had an affective or personality disorder.

Cost-effectiveness of dialectical behaviour therapy vs. enhanced usual care in the treatment of adolescents with self-harm.

BACKGROUND: Studies have shown that dialectical behaviour therapy (DBT) is effective in reducing self-harm in adults and adolescents. AIMS: To evaluate the cost-effectiveness of DBT for adolescents (DBT-A) compared to enhanced usual care (EUC). METHODS: In a randomised study, 77 adolescents with repeated self-harm were allocated to 19 weeks of outpatient treatment, either DBT-A (n = 39) or EUC (n = 38). Cost-effective analyses, including estimation of incremental cost-effectiveness ratios, were conducted with self-harm and global functioning (CGAS) as health outcomes. RESULTS: Using self-harm as effect outcome measure, the probability of DBT being cost-effective compared to EUC increased with increasing willingness to pay up to a ceiling of 99.5% (threshold of € 1400), while with CGAS as effect outcome measure, this ceiling was 94.9% (threshold of € 1600). CONCLUSIONS: Given the data, DBT-A had a high probability of being a cost-effective treatment.

The impact of borderline personality disorder and sub-threshold borderline personality disorder on the course of self-reported and clinician-rated depression in self-harming adolescents.

BACKGROUND: Studies on adults suggest that the presence of comorbid depression and Borderline Personality Disorder (BPD) is associated with an elevated risk of self-harming behaviours and that self-harming behaviours, when present, will have higher severity. This comorbidity, furthermore, complicates clinical assessments, which may be an obstacle to early identification and proper intervention. Adolescents who self-harm frequently report high levels of depressive symptoms, but this is often not reflected in the clinicians' assessment. BPD is still a controversial diagnosis in young people, and less is known about the clinical significance of comorbid BPD in adolescent populations.The purpose of the present study was to examine the impact of BPD on the assessment and course of self-reported and clinician-rated depression in self-harming adolescents before and after a treatment period of 19 weeks. We hypothesized that, compared to adolescents without BPD, adolescents with BPD would self-report higher levels of depression at baseline, and that they would have less reduction in depressive symptoms. METHODS: A total of 39 adolescents with depressive disorders and BPD-traits participating in a randomised controlled trial on treatment of self-harm with Dialectical Behaviour Therapy adapted for Adolescents or enhanced usual care were included. Adolescents with full-syndrome BPD (n = 10) were compared with adolescents with sub-threshold BPD (n = 29) with respect to their self-reported and clinician-rated depressive symptoms, suicidal ideation and global level of functioning at baseline, and after 19 weeks of treatment (end of trial period). RESULTS: At baseline, adolescents with full-syndrome BPD self-reported significantly higher levels of depressive symptoms and suicidal ideation compared to adolescents with sub-threshold BPD, whereas the two groups were rated as equally depressed by the clinicians. At trial completion, all participants had a significant reduction in suicidal ideation, however, adolescents with BPD had a poorer treatment outcome in terms of significantly higher levels of clinician-rated and self-reported depressive symptoms and significantly lower levels of global functioning. At baseline as well as at trial completion, self-reported and clinician-rated levels of depressive symptoms were not significantly correlated in adolescents with BPD. In a multiple linear regression analysis, a diagnosis of BPD and a high baseline level of clinician-rated depressive symptoms predicted higher levels of depressive symptoms at trial completion, whereas receiving Dialectical Behaviour Therapy predicted lower levels of depressive symptoms. CONCLUSION: Our findings suggest that a diagnosis of BPD may have a strong impact on the assessment and course of depressive symptoms in self-harming adolescents. Although rated as equally depressed, adolescents with BPD self-reported significantly higher levels of depressive symptoms and suicidal ideation at baseline, and showed a poorer outcome in terms of higher levels of depressive symptoms and lower levels of global functioning at trial completion compared to adolescents with sub-threshold BPD. Our findings suggest that receiving Dialectical Behaviour Therapy could lead to a greater reduction in depressive symptoms, although firm conclusions cannot be drawn given the limited sample size.Clinicians should be aware of the possibility of underestimating the severity of depression in the context of emotional and behavioral dysregulation. Providing BPD specific treatments seems to be important to achieve sufficient treatment response with regard to depressive symptoms in adolescents with BPD-traits. TRIAL REGISTRATION: Treatment for Adolescents With Deliberate Self Harm; NCT00675129, registered May 2008.

Adolescent suicide attempters: what predicts future suicidal acts?

Predictors for repetition of suicide attempts were evaluated among 92 adolescent suicide attempters 9 years after an index suicide attempt (90% females). Five were dead, two by suicide. Thirty-one (42%) of 73 had repeated a suicide attempt. In multiple Cox regression analysis, four factors had an independent predictive effect: comorbid disorders, hopelessness, having ever received treatment for mental or behavior problems, and having a father exerting control without affection. Prediction on an individual level was difficult. Since almost half repeated a suicidal act, the best strategy is to evaluate all adolescent suicide attempters thoroughly and provide treatment as needed.

[Bipolar disorders in children and adolescents]. / Bipolare lidelser hos barn og ungdom.

BACKGROUND: Bipolar disorders often develop in children and adolescents but are seldom diagnosed before adulthood. These illnesses are associated with considerable morbidity and mortality. The aim of this paper is to provide knowledge to facilitate earlier diagnosis. MATERIAL AND METHOD: Medline search. RESULTS: Bipolar disorders are characterised by serious fluctuations in energy and mood. The diagnosis of bipolar disorders in children and adolescents is challenging because the clinical presentation is influenced by ongoing neural development, which cause considerable symptom overlap and comorbidity with ADHD, conduct disorders, anxiety and Tourette's syndrome. ADHD symptoms may be a precursor of bipolar disorder among some of the youngest children, and prepubertal depression is often pre-bipolar.

[Life leaves its marks]. / Livet setter sine spor.

BACKGROUND: The article highlights how environmental factors early in life, in combination with genetic vulnerability, can influence development and partly explain variations in mental health. MATERIAL AND METHOD: A selection of key articles identified on Medline. RESULT: The plasticity of a child's brain makes it particularly susceptible to environmental factors. This provides a significant potential for learning and adaptation, but also causes vulnerability with respect to, for instance, mental illness. There are no studies showing that a specific trauma or strain causes a specific psychological disorder later in life. Nonetheless, recent studies show that certain environmental factors in early life could have a lasting impact on a child's psychosocial behaviour. The article sums up some of these findings. CONCLUSION: Early preventive measures are particularly important in cases where a biological vulnerability occurs. It is equally important to have realistic expectations with respect to the results of the various measures. Not everything can be returned to normalcy, though it is always possible to promote a development potential.

Dialectical Behavior Therapy Compared With Enhanced Usual Care for Adolescents With Repeated Suicidal and Self-Harming Behavior: Outcomes Over a One-Year Follow-Up.

OBJECTIVE: We conducted a 1-year prospective follow-up study of posttreatment clinical outcomes in adolescents with recent and repetitive self-harm who had been randomly allocated to receive 19 weeks of either dialectical behavior therapy adapted for adolescents (DBT-A) or enhanced usual care (EUC) at community child and adolescent psychiatric outpatient clinics. METHOD: Assessments of self-harm, suicidal ideation, depression, hopelessness, borderline symptoms, and global level of functioning were made at the end of the 19-week treatment period and at follow-up 1 year later. Altogether 75 of the 77 (97%) adolescents participated at both time points. Frequencies of hospitalizations, emergency department visits and other use of mental health care during the 1-year follow-up period were recorded. Change analyses were performed using mixed effects linear spline regression and mixed effect Poisson regression with robust variance. RESULTS: Over the 52-week follow-up period, DBT-A remained superior to EUC in reducing the frequency of self-harm. For other outcomes such as suicidal ideation, hopelessness, and depressive or borderline symptoms and for the global level of functioning, inter-group differences apparent at the 19-week assessment were no longer observed, mainly due to participants in the EUC group having significantly improved on these dimensions over the follow-up year, whereas DBT-A participants remained unchanged. CONCLUSION: A stronger long-term reduction in self-harm and a more rapid recovery in suicidal ideation, depression, and borderline symptoms suggest that DBT-A may be a favorable treatment alternative for adolescents with repetitive self-harming behavior. CLINICAL TRIAL REGISTRATION INFORMATION: Treatment for Adolescents With Deliberate Self Harm; http://clinicaltrials.gov/; NCT00675129.

Intoxicants and suicidal behaviour among adolescents: changes in levels and associations from 1992 to 2002.

AIMS: To assess whether a substantial increase in substance use over a 10-year period has had an impact on the level of, or associations with, non-fatal suicidal behaviour among Norwegian teenagers. DESIGN, SETTING AND PARTICIPANTS: Two cross-sectional school surveys applying identical procedures and measures in 1992 and 2002, using national samples comprising 11 000 and 12 000 13-19-year-old students. FINDINGS: A significant proportion of the increase in the prevalence of attempted suicide among girls could be attributed to the increase in substance use, taking into account other risk and protective factors. Among boys no net increase in the prevalence of attempted suicide was observed, and the impact of substance use on suicidal behaviour was lower in 2002 than in 1992. Yet, it also appeared that unobserved protective factors may have countered the impact of increased substance use among boys. For both genders a larger fraction of attempted suicides was attributable to alcohol intoxication than to use of any other substance. CONCLUSIONS: A significant increase in use of alcohol and drugs may not necessarily be reflected in changes in the level of suicidal behaviour. Further studies applying other data sources and designs are warranted to supplement and validate the present findings.

Suicidal and nonsuicidal adolescents: different factors contribute to self-esteem.

Some risk and protective factors differ in their importance to suicidal and nonsuicidal people. In this research we explore the cross-sectional differences between risk factors among suicidal adolescents and nonsuicidal adolescents by focusing on self-esteem. Sixty-five suicidal and 390 nonsuicidal adolescents were compared on Harter's Self-Perceived Profile for Adolescents, self-concept stability, seeking support, loneliness, and depression. Self-concept stability, loneliness, and peer support correlated differently with self-esteem. In multivariate regression analyses, variance in self-esteem was explained by depression and loneliness, and among nonsuicidal adolescents also by self-concept stability, support, and competencies. Loneliness and self-concept stability related differently to self-esteem in suicidal and nonsuicidal adolescents. When the aim is to enhance self-esteem, this difference may delineate suicidal subgroups that need special interventions.

Characteristics of suicide notes of children and young adolescents: an examination of the notes from suicide victims 15 years and younger.

OBJECTIVE: By analysing the suicide notes from suicide victims 15 years and younger, we attempt to gain insight into the process leading to youth suicide and explore the characteristics of the note writers. METHOD: During a psychological autopsy on 42 youths, we were entrusted with 23 suicide notes in which we explored the themes and compared the note writers to the non-note writers. RESULTS: The key messages were as follows: explain the reason for suicide, declare love and give instructions. The note writers had showed suicidal behaviour more frequently than non-note writers. CONCLUSION: In the notes from youth suicide victims they present themselves as fully responsible and without confusion or overwhelming despair. The notes are likely equally informative as the notes of older victims.