title: Suicide in children and young people in England: a consecutive case series.
abstract: BACKGROUND
  There is concern about the mental health of children and young people and a possible rise in suicidal behaviour in this group. We have done a comprehensive national multi-agency study of suicide in under 20s in England. We aimed to establish how frequently suicide is preceded by child-specific and young person-specific suicide risk factors, as well as all-age factors, and to identify contact with health-care and social-care services and justice agencies.
  
  
  METHODS
  This study is a descriptive examination of suicide in a national consecutive sample of children and young people younger than 20 years who died by suicide in England between Jan 1, 2014, and April 30, 2015. We obtained general population mortality data from the Office for National Statistics (ONS). We collected information about antecedents considered to be relevant to suicide (eg, abuse, bullying, bereavement, academic pressures, self-harm, and physical health) from a range of investigations and inquiries, including coroner inquest hearings, child death investigations, criminal justice system reports, and the National Health Service, including data on people in contact with mental health services in the 12 months before their death.
  
  
  RESULTS
  145 suicides in people younger than 20 years were notified to us during the study period, of which we were able to obtain report data about antecedents for 130 (90%). The number of suicides rose sharply during the late teens with 79 deaths by suicide in people aged 18-19 years compared with 66 in people younger than 18 years. 102 (70%) deaths were in males. 92 (63%) deaths were by hanging. Various antecedents were reported among the individuals for whom we had report data, including academic (especially exam) pressures (35 [27%] individuals), bullying (28 [22%]), bereavement (36 [28%]), suicide in family or friends (17 [13%]), physical health conditions (47 [36%]), family problems (44 [34%]), social isolation or withdrawal (33 [25%]), child abuse or neglect (20 [15%]), excessive drinking (34 [26%]), and illicit drug use (38 [29%]). Suicide-related internet use was recorded in 30 (23%) cases. In the week before death 13 (10%) individuals had self-harmed and 35 (27%) had expressed suicidal ideas. 56 (43%) individuals had no known contact with health-care and social-care services or justice agencies.
  
  
  CONCLUSIONS
  Improved services for self-harm and mental health are crucial to suicide prevention, but the wide range of antecedents emphasises the roles of schools, primary care, social services, and the youth justice system.
  
  
  BACKGROUND
  The Healthcare Quality Improvement Partnership.
authors.affiliation: National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, Jean McFarlane Building, University of Manchester, Manchester, UK. Electronic address: cathryn.a.rodway@manchester.ac.uk.
authors.forename: Cathryn
authors.initials: C
authors.lastname: Rodway
authors.affiliation: National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, Jean McFarlane Building, University of Manchester, Manchester, UK.
authors.forename: Su-Gwan
authors.initials: SG
authors.lastname: Tham
authors.affiliation: National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, Jean McFarlane Building, University of Manchester, Manchester, UK.
authors.forename: Saied
authors.initials: S
authors.lastname: Ibrahim
authors.affiliation: National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, Jean McFarlane Building, University of Manchester, Manchester, UK.
authors.forename: Pauline
authors.initials: P
authors.lastname: Turnbull
authors.affiliation: National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, Jean McFarlane Building, University of Manchester, Manchester, UK.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Windfuhr
authors.affiliation: National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, Jean McFarlane Building, University of Manchester, Manchester, UK.
authors.forename: Jenny
authors.initials: J
authors.lastname: Shaw
authors.affiliation: National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, Jean McFarlane Building, University of Manchester, Manchester, UK.
authors.forename: Nav
authors.initials: N
authors.lastname: Kapur
authors.affiliation: National Confidential Inquiry into Suicide and Homicide by People with Mental Illness, Centre for Mental Health and Safety, Jean McFarlane Building, University of Manchester, Manchester, UK.
authors.forename: Louis
authors.initials: L
authors.lastname: Appleby
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D013405:Suicide / Q000706:statistics & numerical data*; D055815:Young Adult