title: Sex differences in suicides among children and youth: the potential impact of help-seeking behaviour.
abstract: OBJECTIVE
  To describe sex differences in health service use among children and youth who died by suicide.
  
  
  METHODS
  This is a retrospective study of children and youth (aged 10 to 25 years) living in Ontario who died by suicide between April 1, 2003, and December 31, 2007. Coroner records were individually linked to outpatient physician visit, emergency department (ED) presentation, and inpatient stay administrative health care records for 724 people (192 girls and 532 boys). Only 77 (10.6%) were aged 10 to 15 years. The health services types used, number of contacts made, and the last contact were compared in boys and girls.
  
  
  RESULTS
  About 80% of subjects had contact with the health care system in the year before their death, typically to an outpatient physician and (or) the ED. However, not all were seen for mental health reasons. Girls had more outpatient physician and ED contact than boys and closer in time to their death. Further, girls were more likely than boys to have contact in more than one setting. Still, boys and girls did not differ in their use of an outpatient psychiatrist, some ED presentations, and in the nature and number of inpatient stays.
  
  
  CONCLUSIONS
  While most people were seen by an outpatient physician and (or) in the ED in the year before their death, not all received mental health care. Further research is needed to determine whether boys and girls who died by suicide differ from their peers in their health service use to guide preventive interventions.
authors.affiliation: St Michael's Hospital, Toronto, Ontario, Canada. rhodesa@smh.ca
authors.forename: Anne E
authors.initials: AE
authors.lastname: Rhodes
authors.forename: Saba
authors.initials: S
authors.lastname: Khan
authors.forename: Michael H
authors.initials: MH
authors.lastname: Boyle
authors.forename: Lil
authors.initials: L
authors.lastname: Tonmyr
authors.forename: Christine
authors.initials: C
authors.lastname: Wekerle
authors.forename: Deborah
authors.initials: D
authors.lastname: Goodman
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bethell
authors.forename: Bruce
authors.initials: B
authors.lastname: Leslie
authors.forename: Hong
authors.initials: H
authors.lastname: Lu
authors.forename: Ian
authors.initials: I
authors.lastname: Manion
mesh_terms: D000293:Adolescent; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data; D002648:Child; D002652:Child Behavior; D017050:Episode of Care; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D008605:Mental Health Services / Q000706:statistics & numerical data; D020380:Needs Assessment; D009864:Ontario / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D012737:Sex Factors; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data; D055815:Young Adult; D000092864:Suicide Prevention
keywords: adolescent; child; mental health services; sex distribution; suicide