Repetition of attempted suicide among teenagers in Europe: frequency, timing and risk factors.

BACKGROUND: Adolescents in many countries show high rates of suicide attempts and repetitions of attempts as a common feature. Attempted suicide is the best predictor of future suicide. Repetition of attempts further increases the risk of suicide. The present study sought to identify patterns and risk factors for repetition of attempts in older teenagers. METHODS: Data were collected by uniform procedures in a longitudinal follow-up study in seven European centres participating in the WHO/EURO Multicentre Study on Suicidal Behaviour. Information on attempted suicide in the 15-19-year age group during the period 1989-1995 was analysed. RESULTS: A total of 1,720 attempts by 1,264 individuals over a mean follow-up period of 204 weeks (SD 108.9) were recorded. When life-table analysis was performed, 24% of the individuals who had previously attempted suicide made another attempt within one year after the index attempt, compared with 6.8% of the "first-evers", with no major gender difference. Cox regression analysis revealed that previous attempted suicide (OR 3.3, 95% CI 2.4-4.4) and use of "hard" methods (OR 1.5, 95% CI 1.1-2.1) were both significantly associated with repetition of attempted suicide. Stepwise Cox regression analysis showed that a history of previous attempted suicide was the most important independent predictor of repetition (OR 3.2, 95% CI 2.4-4.4). CONCLUSION: For young suicide attempters, follow-up and adequate aftercare are very important if repetition and risk of suicide are to be reduced. This applies particularly to those who have already made more than one attempt.

Recommended care for young people (15-19 years) after suicide attempts in certain European countries.

Data on recommended care for young people aged 15-19 years after attempted suicide from nine European research centres during the period 1989-1992 were analysed in terms of gender, history of previous suicide attempt and methods used. Altogether 438 suicide attempts made by 353 boys and 1,102 suicide attempts made by 941 girls were included. Analyses of the total data from all centres showed that young people with a history of previous suicide attempt and those using violent methods had significantly higher chance of being recommended aftercare than first-time attempters or those choosing self-poisoning. There were no significant differences of being recommended care between genders. Logistic regression analyses of the material were performed and the results were similar. Both having previous attempted suicide (odds ratio 2.0, 95% CI 1.53-2.61) and using "hard" methods (odds ratio 1.71, 95% CI 1.49-1.96) were significantly associated with increased possibility of being recommended aftercare. When individual centres were analysed, large disparities of recommended care after suicide attempts were found and there were no uniform criteria of recommending care for young suicide attempters in Europe.

Lack of continuity--a problem in the care of young suicides.

The course of the psychiatric in-patient treatment received by 34 young people aged 15-24 years before their deaths from suicide was studied retrospectively on the basis of medical records. The quality of the care that they were given was appraised in terms of continuity, an important aspect of the care of young individuals during a period of dynamic development. There were two suicides among patients in child psychiatric care and 32 suicides among those in adult psychiatric care. Continuity of child psychiatric care was satisfactory, while the striking discontinuity in adult psychiatric care, in terms of contacts with doctors, therapists and other staff, with from 3 to 30 different doctors being involved during the period of care, may have been a factor contributing to the suicidal outcome in these cases. In total, 20 of the 34 young people had reported previously known suicide attempts, and notes concerning suicidal communication were mentioned in all but three of the records, while in only three of the records had any form of suicide-risk assessment been noted at the last care session before the suicide. Information about the suicidal process was thus available for most of these records but, as a rule, suicidal analyses were nevertheless lacking.

Relation between attempted suicide and suicide rates among young people in Europe.

STUDY OBJECTIVE: To determine if there are associations between rates of suicide and attempted suicide in 15-24 year olds in different countries in Europe. DESIGN: Attempted suicide rates were based on data collected in centres in Europe between 1989 and 1992 as part of the WHO/EURO Multicentre Study of Parasuicide. Comparison was made with both national suicide rates and local suicide rates for the areas in which the attempted suicide monitoring centres are based. SETTING: 15 centres in 13 European countries. PATIENTS: Young people aged 15-24 years who had taken overdoses or deliberately injured themselves and been identified in health care facilities. MAIN RESULTS: There were positive correlations (Spearman rank order) between rates of attempted suicide and suicide rates in both sexes. The correlations only reached statistical significance for male subjects: regional suicide rates, r = 0.65, p < 0.02; national suicide rates, r = 0.55, p < 0.02. CONCLUSIONS: Rates of attempted suicide and suicide in the young covary. The recent increase in attempted suicide rates in young male subjects in several European countries could herald a further increase in suicide rates.

Suicide among young people aged 10-29 in Sweden.

This study analyses the incidence of suicide among children and young people aged between 10 and 29 in Sweden, during the period 1974-1986. The study comprises 4,624 individuals whose deaths were the outcome of verified, E950-E959 (n = 3,511) and undetermined, E980-E989 (n = 1,113) suicides. Regression analysis of different age groups separately and all age groups combined shows that the frequency of suicide among children and young people in Sweden did not increase in this period. Nonetheless, mortality figures are high, especially for boys and young men aged 15-29. The maximum suicide-mortality rate (43.2 per 10,000) is noted for young men aged 25-29 in 1984. The male-female ratio with respect to deaths from suicide is 2.5 for the entire group, the smallest difference being in the 15-19 age group (1.7) and the largest in the 25-29 age group (2.8). Methods of committing suicide vary between the sexes and the various age groups. Boys and young men use violent methods more often, and this situation has remained stable throughout the 13-year period. Girls use non-violent methods to a greater extent, but young women aged 18-29 use violent and non-violent methods to almost the same extent. During the 13-year period studied, a change took place in the girls' and young women's choice of methods towards more violent methods in the 1980s compared with the 1970s. Regardless of sex, there are significantly (p less than 0.001) fewer married and more divorced people among those committing suicide compared with corresponding age groups in the overall population.

Premature chromosome condensation in childhood acute lymphoblastic leukaemia: correlation of proliferative potential index in blood and marrow.

The proliferative potential index (PPI), which is the proportion of all GI cells which are in late GI, has been shown to reflect disease state in patients with acute leukaemia. We have determined PPI in paired blood and marrow samples from children with acute lymphoblastic leukaemia (ALL) at different stages of the disease, and found a close correlation between blood and marrow PPI irrespective of disease stage. Therefore blood PPI can replace marrow PPI for monitoring disease control in ALL.