Suicide Rate in Canadian Girls Increasing

Fran Lowry

April 02, 2012

April 2, 2012 — Suicide rates in Canada are increasing in girls aged 10 to 19 years, but they are decreasing among boys in that age group, new data show.

The preferred method of suicide is suffocation, whereas use of poison and guns is declining, researchers Robin Skinner, MSP, and Stephen McFaull, MSc, from the Public Health Agency of Canada, report in an article published April 2 in the Canadian Medical Association Journal.

"Suicide is the second leading cause of death for young Canadians (10 - 19 years of age) — a disturbing trend that has shown little improvement in recent years," the authors write.

"Risk factors for suicidal behaviour and ideation in young people include a psychiatric diagnosis (e.g., depression), substance abuse, past suicidal behaviour, family factors and other life stressors (e.g., relationships, bullying) that have complex interactions," they note.

In addition, "pro-suicide" sites on the Internet may increase the risk for suicide even more by providing details on the various ways to commit suicide and by evaluating these methods with regard to their effectiveness, the amount of pain involved, and the length of time to produce death, they write.

Suffocation Primary Cause

The aim of the study was to examine suicide trends among Canadian children and adolescents.

The investigators conducted a retrospective analysis of standardized suicide rates using Statistics Canada mortality data for the period from 1980 to 2008. They analyzed the data by sex and by suicide method over time for 2 age groups: children aged 10 to 14 years, and adolescents aged 15 to 19 years.

In 2008, the analysis showed that there were 233 suicides in young Canadians aged 10 to 19 years, accounting for 20.4% of all deaths in that age group.

Overall, the suicide rate decreased by 1.0% per year between 1980 and 2008 (95% confidence interval [CI], -1.5 to -0.4) for both age groups. However, when the researchers stratified the data by age and sex, they found significant variation.

Among children aged 10 to 14 years, the suicide rate was 1.2 per 100,000. Of these 25 deaths, 64% were in males, and 88% were due to suffocation.

Among adolescents aged 15 to 19 years, the overall suicide rate in 2008 was 9.2 per 100,000; of these 208 deaths, 67% were in males, and suffocation was again the primary cause of death, responsible for 73% of the suicides in boys and 78% of the suicides in girls.

More Research Needed

Suicide rates among boys aged 10 to 14 years did not change significantly throughout the 29-year study period; the overall rate was 1.6 per 100,000 in 2008.

Suicide rates among male adolescents aged 15 to 19 years showed a downward trend, going from 19.0 per 100,000 in 1980 to 12.1 per 100,000 in 2008. Also, suicides by firearms began to decline in 1992; such suicides declined by an average of 6.7% annually, whereas suicides by suffocation increased by 1.8% per year. Poisoning also decreased to 0.8 per 100,000 in 2008.

In girls aged 10 to 14 years, suicide rates increased sporadically from 0.6 per 100,000 in 1980 to 0.9 per 100,000 in 2008.

Among girls in this age category, suicide by suffocation increased 8.1% each year (95% CI, 6.0 - 10.4), but deaths from poisoning decreased by an average of 2.9% per year. There was no significant change in suicides involving guns in this age group.

Among teenage girls aged 15 to 19 years, suicide rates increased from 3.7 per 100,000 in 1980 to 6.2 per 100,000 in 2008, for an annual increase in rate of 1.8% per year (95% CI, 1.0 - 2.5).

As with the younger girls, suicide by suffocation increased each year by 8.0%. However, suicide with guns decreased 7.8% per year, and suicide from poisoning decreased 4.6% per year.

"Limiting access to firearms, poisons and elevated structures has some potential to mitigate the risk of suicide; however, suffocation, the predominant means of committing suicide among boys and girls, is not amenable to this type of primary prevention," the authors write.

"Additional research is required to understand the complex factors involved in this phenomenon and to develop prevention initiatives that address a changing landscape," they conclude.

Worldwide Problem

In an accompanying editorial, Laurence J. Kirmayer, MD, from McGill University, Montreal, Canada, writes that the results of this study are consistent with data from other countries.

Dr. Kirmayer writes that the Internet has provided explicit information on methods of suicide and that this may increase suicidal ideation in vulnerable youth, as well as influence their choice of method should they decide to take their own life.

But he emphasizes that social and economic deprivation is associated with higher rates of suicide, and that the Internet, with its ability to convey "vivid images of autonomy, mobility and conspicuous consumption," may intensify feelings of deprivation among children in deprived areas.

"These adversities are particularly relevant for Aboriginal youth in many communities across Canada. Both male and female Aboriginal youth die from suicide at rates much higher than their non-Aboriginal counterparts. Hence, Aboriginal youth are likely over-represented in these numbers," Dr. Kirmayer notes.

"Understanding the determinants on young people's identities, resilience and well-being may hold the key to future reductions in suicide," he concludes.

Mr. Skinner, Mr. McFaull, and Dr. Kirmayer have disclosed no relevant financial relationships.

CMAJ. Published online April 2, 2012. Full article

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