Our new paper from the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH), the first to investigate a complete national sample of individual suicides by young people, describes the stresses young people face before they take their lives.

Worldwide suicide is most common in young people, and in many places rates of self-harm and suicide are rising, especially in girls. With this in mind, we wanted to explore the characteristics of suicide in young people, including gender differences and contacts with services that could play a part in prevention.

Our paper collected data from a range of investigations by official bodies that can occur when a young person dies, mainly from coroners. Reports from these investigations are a rich source of information that allowed us to examine the detailed personal testimony from people closest to the young person on the stresses they were facing before they died. In a 3-year period, we found almost 600 people aged 10-19 died by suicide in the UK. 71% of the young people who died were male. However, many of the stresses we identified, including family mental-illness and domestic violence, abuse, bereavement, bullying, facing exams or exam results, physical health conditions, and self-harm were more common in girls. 74% of girls compared to 55% of boys were in contact with services.

We also looked at particular sub-groups. We found looked after children had higher rates of abuse, housing problems, bereavement, and substance misuse than young people not in care. For young people who identified as lesbian, gay, bisexual and transgender (LGBT) bullying, previous self-harm and suicidal ideas were more common. 9% of young people had been bereaved by suicide.

Our study shows the range of adversities young people were facing prior to death. We cannot say whether these experiences have contributed to the rise in suicide in young people over recent years but we suggest they highlight the need for an approach to suicide prevention that incorporates education, social care, health services and the third sector. A better understanding of how to look after emotional health is also needed through schools, universities, public health and the media. We also believe there are specific needs for some groups of young people: housing and mental health support for looked after children; antibullying measures for LGBT groups as well as a more general shift in attitude towards diversity; and support for bereaved families.

There are also many society-wide challenges young people face which we did not examine that may contribute to suicide risk – economic adversity, job and housing insecurities, fears about opportunity and the environment, and a demand for mental healthcare that services may be struggling to respond to. Continuing research is therefore vital.

Children and young people who die by suicide: childhood-related antecedents, gender differences and service contact
Cathryn Rodway, Su-Gwan Tham, Saied Ibrahim, Pauline Turnbull, Nav Kapur and Louis Appleby

Why I chose this article
It is a pleasure to recognize “Children and young people who die by suicide: childhood-related antecedents, gender differences and service contact”. With the increasing rates of suicide in younger persons, especially girls, it is important to explore potential antecedents and gender differences. Rodway et al. performed a 3-year nationwide consecutive case series study of deaths by suicide (including probable suicide) in young persons aged 10-19 based on investigations from official bodies. Findings addressed rates of suicide, methods of suicide, common antecedents, and service contacts with comparison between girls and boys. Though boys more frequently died by suicide, girls were noted to have a more specific pattern of common antecedents. The breadth of antecedents with increasing suicide rates leads to the need for inter-agency interventions, including an increased presence of mental health services and social support. While acknowledging limitations in their findings, the authors addressed the need for continuing research to better understand and prevent suicide and self-harm behaviors in an era of increasing social media and societal stress.

Kenneth Kaufman, Editor-in-Chief, BJPsych Open