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Early adolescent suicide: a comparative study
Journal of Clinical Forensic Medicine (2000) 7, 6–9 © APS/Harcourt Publishers Ltd 2000
ORIGINAL COMMUNICATION
Early adolescent suicide: a comparative study R. W. Byard,1,2 D. Markopoulos,2 D. Prasad,2 D. Eitzen,1 R. A. James,1 B. Blackbourne,3 H. F. Krous4 1
Forensic Science Centre, Adelaide, Australia University of Adelaide, Adelaide, Australia 3 Medical Examiner’s Office, San Diego, USA 4 Children’s Hospital San Diego, San Diego, USA 2
SUMMARY. A study was undertaken of suicides in children and adolescents aged 16 years and under in South Australia, (Australia), and in San Diego County (USA) from January 1985 to December 1997. In South Australia there were 48 cases of youth suicide, representing 2% of the total number of 2251 suicides over that time. There were 34 males and 14 females (age range 13 to 16 years; mean = 15.3 years), with 22 hangings (46%), six gunshot wounds (13%), five train deaths (10%), four drug overdoses (8%), four jumping deaths (8%), three self immolations (6%), three carbon-monoxide inhalations (6%) and one electrocution (2%). In San Diego County there were 70 cases, representing 1.6% of the total number of 4492 suicides. There were 48 males and 22 females (age range 11 to 16 years; mean = 14.7 years), with 41 gunshot wounds (59%), 21 hangings (30%), six drug overdoses (9%), and two jumping deaths (3%). Preferred methods of suicide differed between the two areas, with significantly more gunshot suicides in San Diego compared to South Australia. The methods of suicide also differed in South Australia from older age groups, with more hangings, jumping deaths and self immolations, and fewer firearm and carbon monoxide inhalation deaths. Suicides in adolescents under the age of 17 years in both populations were, however, rare, with no demonstrable increase in numbers over the time of the study. © APS/Harcourt Publishers Ltd 2000 Journal of Clinical Forensic Medicine (2000) 7, 6–9
INTRODUCTION
MATERIALS AND METHODS
Youth suicide has been gaining increasing public attention in Australia and other countries, including the USA, with concerns being expressed that significant increases in numbers of these deaths were occurring.1 The present study was undertaken to review the features of such deaths in a series of children and adolescents under the age of 17 years in Australia, and to compare them to a group of similar age from the USA.
The files of the Forensic Science Centre, South Australia, and the Medical Examiner’s Office, San Diego County, California, were searched for all cases registered as suicide in individuals under the age of 17 years, over a 13-year period from January 1985 to December 1997. The Forensic Science Centre provides autopsy services to the State Coroner for the state of South Australia, Australia, and the San Diego Medical Examiner’s Office provides a similar service for the population of San Diego County, California. It is recognized that a small number of certain types of fatalities that were classified as accidental, such as drownings and heroin overdoses, may have been suicides, and that other deaths, such as those involving fires and trains may have been suspicious. There may also be under-reporting of very young suicides. However, all cases in this study had undergone
Roger W. Byard, R. A. James, D. Eitzen Forensic Science Centre, 21 Divett Place, Adelaide 5000, Australia. D. Markopoulos, D. Prasad, University of Adelaide, Australia. B. Blackbourne, Medical Examiner’s Office, San Diego, USA H. F. Krous, Children’s Hospital San Diego, San Diego, USA Correspondence to: Roger W. Byard, Tel.: +61 8 8226 7700; fax: + 61 8 8226 7777; e-mail: [email protected] 6
Early adolescent suicide Table 1 Details of methods of suicide by gender in 48 adolescents under the age of 17 years in South Australia from 1985 to 1997 Method
Table 2 Details of methods of suicide by gender in 48 adolescents under the age of 17 years in San Diego county, California from 1985 to 1997
Male (n = 34) Female (n = 14) Total (n = 48) Method
Hanging Gunshot Train Overdose Jumping Self-immolation Carbon monoxide Electrocution
7
19 6 3 1 2 1 2 0
3 0 2 3 2 2 1 1
22 (46%) 6 (13%) 5 (10%) 4 (8%) 4 (8%) 3 (6%) 3 (6%) 1 (2%)
Gunshot Hanging Overdose Jumping
Male (n = 48)
Female (n = 22)
Total (n = 70)
31 14 1 2
10 7 5 0
41 (59%) 21 (30%) 6 (9%) 2 (3%)
Number of Suicides
Number of Suicides
Male Female
Year Age in years
full forensic autopsies incorporating formal police investigations prior to the deaths being recorded as suicides. Details of the year of death, age and sex of the victim, and method of suicide were extracted from the records and tabulated.
Fig. 2 Number of suicides per calendar year by gender in adolescents under the age of 17 years in South Australia from 1985 to 1997.
Number of Suicides
Fig. 1 Number of suicides per year of age in adolescents under the age of 17 years in South Australia from 1985 to 1997.
RESULTS South Australia Of the total of 48 cases, there were 34 males and 14 females (age range 13–16 years; mean = 15.3 years). The age distribution is shown in Figure 1. There were 22 hangings (46%), six gunshot wounds (13%), five train deaths (10%), four drug overdoses (8%), four jumping deaths (8%), three self immolations (6%), three carbon-monoxide inhalations (6%) and one electrocution (2%) (Table 1). Figure 2 depicts the numbers of male and female suicides per year. No significant changes in annual numbers could be demonstrated over the years of the study. The 48 suicides under the age of 17 years represent 2% of the total of 2251 cases of suicide for all ages registered at the Forensic Science Centre over this period.
Age in years
Fig. 3 Number of suicides per year of age in adolescents under the age of 17 years in San Diego County from 1985 to 1997
San Diego Country Of the total of 70 cases, there were 48 males and 22 females (age range 11–16 years; mean = 14.7 years). The age distribution is shown in Figure 3. There were 41 gunshot wounds (59%), 21 hangings (30%), six drug overdoses (9%), and two jumping deaths (3%) (Table 2). Figure 4 demonstrates the numbers of male and female suicides per year. No significant changes in annual numbers could be demonstrated over the years of the study. The 70 suicides under the age of 17 years represent 1.6% of the total of 4492 cases of suicide for
Journal of Clinical Forensic Medicine
Male Female
Number of Suicides
8
Year
Fig. 4 Number of suicides per calendar year by gender in adolescents under the age of 17 years in San Diego County from 1985 to 1997
all ages registered at the Medical Examiner’s Office over this period. Given the relatively low numbers in this study absolute numbers have been used, rather than rates per 100 000. It should be noted that as both populations have increased over the 13-year study period (South Australia from 1371 000 in 1985 to 1474 000 in 19952 and San Diego from 2080 300 to 2729 1003,4), bias should be towards an increase in absolute numbers of cases per year, however, this was not seen.
DISCUSSION Although suicide is now the leading cause of violent death in Australia, ahead of homicides and motor vehicle accidents,5,6 the overall suicide rates have changed little in 100 years.7 For example, the rate of male suicides per 100 000 population was 20.6 in 1897, compared to 21 in 1995. The corresponding rates for females are unaltered at 5.5 per 100 000.5 Despite this apparent relative stability, however, there has been a marked shift in the age distribution of suicides, with a decline in victims over the age of 65, counterbalanced by an almost 4-fold increase in numbers of suicides in males aged between 15 and 25 years over the past 3 to 4 decades.8 This increase has also been noted in the USA, Canada, New Zealand and in parts of Europe.9,10 Male suicide rates are generally higher than females in this age group in most countries except China.11 Suicides in older adolescents and young adult males between the ages of 15 to 24 years are often referred to as ‘youth’ suicides,12 with some studies including subjects up to the age of 29 years.13 This may, however, confuse interpretation of suicide rates for children and younger adolescents, i.e. although there has been an undoubted increase in suicides among 15- to 24-year-old males over the past 30 years,7,14 our study has shown that the numbers of
suicides in children under the age of 17 years in South Australia and San Diego over the past 13 years have been small with no appreciable increases. This contrasts with other studies which have suggested that child (under 15 years) suicide is a growing problem.15 For example, it has also been reported that the rate of youth suicide increased in all states but Utah and California between 1970 and 1989.16 In Australia the National Injury Surveillance Unit has reported that the rate of suicides in males aged 15 to 24 years did not increase from 1990 to 1995.11 Further, the suicide rate per 100 000 population in Australia in the 1- to 14-year-old age group does not appear to have increased over the past century, (i.e. the 1- to 14-year-old male suicide rate per 100 000 between 1891 and 1910 was 0.5; in 1964 – 0.2; in 1986 – 0.6; in 1990 – 0.3; and in 1995 – <0.5; and the 1- to14-year-old female suicide rate between 1891 and 1910 was 0.4; in 1964 – 0.2; in 1986 – 0.1; in 1990 – 0.2; and in 1995 – 0).6,17 Although official suicide statistics may be biased towards under-reporting,18 this should be a relatively constant factor. While South Australia has had a relatively stable population over the study period, interpretation of the data from San Diego is not straightforward, as it is complicated by changing demographics and population numbers. For example, the proportion of nonwhites and Hispanics in the overall Californian population between 1970 and 1990 has almost doubled.16 Given the lower rates of suicides among non-whites, the reduction in suicide rate in California has been attributed at least in part to this change in racial composition. It has been stated that age is not a factor in the selection of methods of suicide,5 however, this may not apply to childhood or adolescent suicides. For example, while hanging, carbon-monoxide inhalation, gunshots and overdoses account for greater than 90% of suicides overall in Australia,5 they represent only 73% of the total in the South Australian youth cases. This is reflected in the increased percentage of less common methods of suicide such as lying or standing in front of oncoming trains, jumping from buildings and self-immolation. There was also a marked difference in the preferred method of suicide between the South Australian and San Diego groups, with a strong preference for firearms in the North American population. Determining the precise reasons for these differences in methods of suicide is beyond the scope of the present study, however, accessibility to injurious agents may be a significant factor.19,20 For example, the lower numbers of firearm suicides in South Australia may be a result of the greater restrictions to firearms access that exist in Australia compared to the USA.
Early adolescent suicide The lower numbers of carbon-monoxide inhalations in both groups is quite likely a reflection of lack of access to, or familiarity with the complexities of, cars and the paraphernalia required to set up a carbonmonoxide-filled cabin. Similarly, a lack of understanding of the potentially lethal nature of medications may have influenced the relatively low number of drug-overdose deaths, whereas the results of jumping from a building, standing in front of a train or self-immolating, are reasonably clear even to the quite young. In conclusion, this study has shown that preferred methods of suicide in young adolescents in South Australia differ from older age groups, with more deaths from hanging, and fewer deaths from firearms and carbon monoxide. Methods also differ between South Australia and San Diego with far higher numbers of gunshot suicides in the latter. However, suicides of individuals aged under 17 years in both areas was a relatively rare event, with no apparent increase in numbers over the years 1985 to 1997. While it is recognized that the numbers in this study are small, it has been stated that media reports have ‘unfortunately overemphasized the contribution of youth suicides to all suicides’.21 The current data support this contention, with the numbers of deaths due to youth suicide representing only a small fraction (2% and 1.6%) of suicides overall in two quite different populations. Although youth suicide may be increasing in some groups, this may not be a general phenomenon as the trends in, and method of, youth suicide may vary considerably from community to community. ACKNOWLEDGEMENTS We gratefully acknowledge the assistance of Ms Julie Nadeau in compiling data from San Diego, and Mr Wayne Chivell, South Australian State Coroner for permission to publish data from these cases. REFERENCES 1. Lee CJ, Collins KA, Burgess SE. Suicide under the age of eighteen. A 10-year retrospective study. Am J Forensic Sci 1999; 20: 27–30 2. McLennan W. 1997 Year Book Australia. Australian Bureau of Statistics. Canberra: Australian Government Publishing Service, p. 74
9
3. State of California, Department of Finance, City/County Population Estimates, with Annual Percent Change, January 1, 1997 and 1998. Sacramento, California, May 1998 4. State of California, Department of Finance, Population Estimates of California Cities and Counties January 1, 1981 to January 1, 1990. Sacramento, California 5. Baume P, McTaggart P. Suicides in Australia. In: Kosky RJ, Eshkevari HS, Goldney RD, Hassan R (eds) Suicide Prevention. The Global Context. New York: Plenum Press, 1998, 67–78 6. Causes of Death, Australia, 1995. Catalogue No. 3303.0. Australian Bureau of Statistics. Canberra: Australian Government Publishing Service, 1996 7. Goldney RD, Harrison J. Suicide in the elderly: some good news. Aust J Age 1998; 2: 54–55 8. Krupinski J, Tiller JWG, Burrows GD, Mackenzie A. Predicting suicide risk among young suicide attempters. In: Kosky RJ, Eshkevari HS, Goldney RD, Hassan R (eds) Hassan R Suicide Prevention. The Global Context. New York: Plenum Press, 1998, 93–97 9. Cantor CH, Leenaars AA, Lester D, Salter PJ, Wolanski AM, O’Toole B. Suicide trends in eight predominantly Englishspeaking countries 1960–1989. Soc Psychiatry Psychiatr Epidemiol 1996; 31: 364–373 10. Pritchard C. New patterns of suicide by age and gender in the United Kingdom and the Western World 1974–1992; an indicator of social change. Soc Psychiatry Psychiatr Epidemiol 1996; 31: 364–373 11. Harrison J, Moller J, Bordeaux S. Youth suicide and selfinjury Australia. Australian Injury Prevention Bulletin, Supplement to Issue 15, 1995 12. Beautrais AL. Risk factors for serious suicide attempts among young people. A case control study. In: Kosky RJ, Eshkevari HS, Goldney RD, Hassan R (eds) Suicide Prevention. The Global Context. New York: Plenum Press, 1998, 167–181 13. Goldney RD. Suicide in the young. J Paediatr Child Health 1993; 29 (Suppl 1): S50–52 14. Tiller JWG, Krupinski J, Burrows GD, Mackenzie A, Hallenstein H, Johnstone G. Youth suicide. The Victorian Coroner’s study. In: Kosky RJ, Eshkevari HS, Goldney RD, Hassan R (eds) Suicide Prevention. The Global Context. New York: Plenum Press, 1998, 87–91 15. Roesler J. The incidence of child suicide in Minnesota. Minn Med 1997; 80: 45–47 16. Males M. California’s suicide decline, 1970–1990. Suic Life Threat Behav 1994; 24: 24–37 17. Hassan R. Suicide Explained: The Australian Experience. Melbourne: Melbourne University Press, 1995, 50 18. O’Donnell I, Farmer R. The limitations of official suicide statistics. Brit J Psychiatr. 1995; 166: 458–461 19. Dudley M, Kelk N, Florio T, Waters B, Howard J, Taylor D. Coroner’s records of rural and non-rural cases of youth suicide in New South Wales. Aust NZ J Psychiatr 1998; 32: 242–251 20. Dudley M, Kelk N, Florio T, Howard J, Waters B, Haski C, Alcock M. Suicide among young rural Australians 1964–1993: a comparison with metropoliton trends. Soc Psychiatry Psychiatr Epidemiol 1997; 32: 251–260 21. Bell CC, Clark DC. Adolescent suicide. Pediatr Clin Nth Am 1998; 45: 365–380
ORIGINAL COMMUNICATION
Early adolescent suicide: a comparative study R. W. Byard,1,2 D. Markopoulos,2 D. Prasad,2 D. Eitzen,1 R. A. James,1 B. Blackbourne,3 H. F. Krous4 1
Forensic Science Centre, Adelaide, Australia University of Adelaide, Adelaide, Australia 3 Medical Examiner’s Office, San Diego, USA 4 Children’s Hospital San Diego, San Diego, USA 2
SUMMARY. A study was undertaken of suicides in children and adolescents aged 16 years and under in South Australia, (Australia), and in San Diego County (USA) from January 1985 to December 1997. In South Australia there were 48 cases of youth suicide, representing 2% of the total number of 2251 suicides over that time. There were 34 males and 14 females (age range 13 to 16 years; mean = 15.3 years), with 22 hangings (46%), six gunshot wounds (13%), five train deaths (10%), four drug overdoses (8%), four jumping deaths (8%), three self immolations (6%), three carbon-monoxide inhalations (6%) and one electrocution (2%). In San Diego County there were 70 cases, representing 1.6% of the total number of 4492 suicides. There were 48 males and 22 females (age range 11 to 16 years; mean = 14.7 years), with 41 gunshot wounds (59%), 21 hangings (30%), six drug overdoses (9%), and two jumping deaths (3%). Preferred methods of suicide differed between the two areas, with significantly more gunshot suicides in San Diego compared to South Australia. The methods of suicide also differed in South Australia from older age groups, with more hangings, jumping deaths and self immolations, and fewer firearm and carbon monoxide inhalation deaths. Suicides in adolescents under the age of 17 years in both populations were, however, rare, with no demonstrable increase in numbers over the time of the study. © APS/Harcourt Publishers Ltd 2000 Journal of Clinical Forensic Medicine (2000) 7, 6–9
INTRODUCTION
MATERIALS AND METHODS
Youth suicide has been gaining increasing public attention in Australia and other countries, including the USA, with concerns being expressed that significant increases in numbers of these deaths were occurring.1 The present study was undertaken to review the features of such deaths in a series of children and adolescents under the age of 17 years in Australia, and to compare them to a group of similar age from the USA.
The files of the Forensic Science Centre, South Australia, and the Medical Examiner’s Office, San Diego County, California, were searched for all cases registered as suicide in individuals under the age of 17 years, over a 13-year period from January 1985 to December 1997. The Forensic Science Centre provides autopsy services to the State Coroner for the state of South Australia, Australia, and the San Diego Medical Examiner’s Office provides a similar service for the population of San Diego County, California. It is recognized that a small number of certain types of fatalities that were classified as accidental, such as drownings and heroin overdoses, may have been suicides, and that other deaths, such as those involving fires and trains may have been suspicious. There may also be under-reporting of very young suicides. However, all cases in this study had undergone
Roger W. Byard, R. A. James, D. Eitzen Forensic Science Centre, 21 Divett Place, Adelaide 5000, Australia. D. Markopoulos, D. Prasad, University of Adelaide, Australia. B. Blackbourne, Medical Examiner’s Office, San Diego, USA H. F. Krous, Children’s Hospital San Diego, San Diego, USA Correspondence to: Roger W. Byard, Tel.: +61 8 8226 7700; fax: + 61 8 8226 7777; e-mail: [email protected] 6
Early adolescent suicide Table 1 Details of methods of suicide by gender in 48 adolescents under the age of 17 years in South Australia from 1985 to 1997 Method
Table 2 Details of methods of suicide by gender in 48 adolescents under the age of 17 years in San Diego county, California from 1985 to 1997
Male (n = 34) Female (n = 14) Total (n = 48) Method
Hanging Gunshot Train Overdose Jumping Self-immolation Carbon monoxide Electrocution
7
19 6 3 1 2 1 2 0
3 0 2 3 2 2 1 1
22 (46%) 6 (13%) 5 (10%) 4 (8%) 4 (8%) 3 (6%) 3 (6%) 1 (2%)
Gunshot Hanging Overdose Jumping
Male (n = 48)
Female (n = 22)
Total (n = 70)
31 14 1 2
10 7 5 0
41 (59%) 21 (30%) 6 (9%) 2 (3%)
Number of Suicides
Number of Suicides
Male Female
Year Age in years
full forensic autopsies incorporating formal police investigations prior to the deaths being recorded as suicides. Details of the year of death, age and sex of the victim, and method of suicide were extracted from the records and tabulated.
Fig. 2 Number of suicides per calendar year by gender in adolescents under the age of 17 years in South Australia from 1985 to 1997.
Number of Suicides
Fig. 1 Number of suicides per year of age in adolescents under the age of 17 years in South Australia from 1985 to 1997.
RESULTS South Australia Of the total of 48 cases, there were 34 males and 14 females (age range 13–16 years; mean = 15.3 years). The age distribution is shown in Figure 1. There were 22 hangings (46%), six gunshot wounds (13%), five train deaths (10%), four drug overdoses (8%), four jumping deaths (8%), three self immolations (6%), three carbon-monoxide inhalations (6%) and one electrocution (2%) (Table 1). Figure 2 depicts the numbers of male and female suicides per year. No significant changes in annual numbers could be demonstrated over the years of the study. The 48 suicides under the age of 17 years represent 2% of the total of 2251 cases of suicide for all ages registered at the Forensic Science Centre over this period.
Age in years
Fig. 3 Number of suicides per year of age in adolescents under the age of 17 years in San Diego County from 1985 to 1997
San Diego Country Of the total of 70 cases, there were 48 males and 22 females (age range 11–16 years; mean = 14.7 years). The age distribution is shown in Figure 3. There were 41 gunshot wounds (59%), 21 hangings (30%), six drug overdoses (9%), and two jumping deaths (3%) (Table 2). Figure 4 demonstrates the numbers of male and female suicides per year. No significant changes in annual numbers could be demonstrated over the years of the study. The 70 suicides under the age of 17 years represent 1.6% of the total of 4492 cases of suicide for
Journal of Clinical Forensic Medicine
Male Female
Number of Suicides
8
Year
Fig. 4 Number of suicides per calendar year by gender in adolescents under the age of 17 years in San Diego County from 1985 to 1997
all ages registered at the Medical Examiner’s Office over this period. Given the relatively low numbers in this study absolute numbers have been used, rather than rates per 100 000. It should be noted that as both populations have increased over the 13-year study period (South Australia from 1371 000 in 1985 to 1474 000 in 19952 and San Diego from 2080 300 to 2729 1003,4), bias should be towards an increase in absolute numbers of cases per year, however, this was not seen.
DISCUSSION Although suicide is now the leading cause of violent death in Australia, ahead of homicides and motor vehicle accidents,5,6 the overall suicide rates have changed little in 100 years.7 For example, the rate of male suicides per 100 000 population was 20.6 in 1897, compared to 21 in 1995. The corresponding rates for females are unaltered at 5.5 per 100 000.5 Despite this apparent relative stability, however, there has been a marked shift in the age distribution of suicides, with a decline in victims over the age of 65, counterbalanced by an almost 4-fold increase in numbers of suicides in males aged between 15 and 25 years over the past 3 to 4 decades.8 This increase has also been noted in the USA, Canada, New Zealand and in parts of Europe.9,10 Male suicide rates are generally higher than females in this age group in most countries except China.11 Suicides in older adolescents and young adult males between the ages of 15 to 24 years are often referred to as ‘youth’ suicides,12 with some studies including subjects up to the age of 29 years.13 This may, however, confuse interpretation of suicide rates for children and younger adolescents, i.e. although there has been an undoubted increase in suicides among 15- to 24-year-old males over the past 30 years,7,14 our study has shown that the numbers of
suicides in children under the age of 17 years in South Australia and San Diego over the past 13 years have been small with no appreciable increases. This contrasts with other studies which have suggested that child (under 15 years) suicide is a growing problem.15 For example, it has also been reported that the rate of youth suicide increased in all states but Utah and California between 1970 and 1989.16 In Australia the National Injury Surveillance Unit has reported that the rate of suicides in males aged 15 to 24 years did not increase from 1990 to 1995.11 Further, the suicide rate per 100 000 population in Australia in the 1- to 14-year-old age group does not appear to have increased over the past century, (i.e. the 1- to 14-year-old male suicide rate per 100 000 between 1891 and 1910 was 0.5; in 1964 – 0.2; in 1986 – 0.6; in 1990 – 0.3; and in 1995 – <0.5; and the 1- to14-year-old female suicide rate between 1891 and 1910 was 0.4; in 1964 – 0.2; in 1986 – 0.1; in 1990 – 0.2; and in 1995 – 0).6,17 Although official suicide statistics may be biased towards under-reporting,18 this should be a relatively constant factor. While South Australia has had a relatively stable population over the study period, interpretation of the data from San Diego is not straightforward, as it is complicated by changing demographics and population numbers. For example, the proportion of nonwhites and Hispanics in the overall Californian population between 1970 and 1990 has almost doubled.16 Given the lower rates of suicides among non-whites, the reduction in suicide rate in California has been attributed at least in part to this change in racial composition. It has been stated that age is not a factor in the selection of methods of suicide,5 however, this may not apply to childhood or adolescent suicides. For example, while hanging, carbon-monoxide inhalation, gunshots and overdoses account for greater than 90% of suicides overall in Australia,5 they represent only 73% of the total in the South Australian youth cases. This is reflected in the increased percentage of less common methods of suicide such as lying or standing in front of oncoming trains, jumping from buildings and self-immolation. There was also a marked difference in the preferred method of suicide between the South Australian and San Diego groups, with a strong preference for firearms in the North American population. Determining the precise reasons for these differences in methods of suicide is beyond the scope of the present study, however, accessibility to injurious agents may be a significant factor.19,20 For example, the lower numbers of firearm suicides in South Australia may be a result of the greater restrictions to firearms access that exist in Australia compared to the USA.
Early adolescent suicide The lower numbers of carbon-monoxide inhalations in both groups is quite likely a reflection of lack of access to, or familiarity with the complexities of, cars and the paraphernalia required to set up a carbonmonoxide-filled cabin. Similarly, a lack of understanding of the potentially lethal nature of medications may have influenced the relatively low number of drug-overdose deaths, whereas the results of jumping from a building, standing in front of a train or self-immolating, are reasonably clear even to the quite young. In conclusion, this study has shown that preferred methods of suicide in young adolescents in South Australia differ from older age groups, with more deaths from hanging, and fewer deaths from firearms and carbon monoxide. Methods also differ between South Australia and San Diego with far higher numbers of gunshot suicides in the latter. However, suicides of individuals aged under 17 years in both areas was a relatively rare event, with no apparent increase in numbers over the years 1985 to 1997. While it is recognized that the numbers in this study are small, it has been stated that media reports have ‘unfortunately overemphasized the contribution of youth suicides to all suicides’.21 The current data support this contention, with the numbers of deaths due to youth suicide representing only a small fraction (2% and 1.6%) of suicides overall in two quite different populations. Although youth suicide may be increasing in some groups, this may not be a general phenomenon as the trends in, and method of, youth suicide may vary considerably from community to community. ACKNOWLEDGEMENTS We gratefully acknowledge the assistance of Ms Julie Nadeau in compiling data from San Diego, and Mr Wayne Chivell, South Australian State Coroner for permission to publish data from these cases. REFERENCES 1. Lee CJ, Collins KA, Burgess SE. Suicide under the age of eighteen. A 10-year retrospective study. Am J Forensic Sci 1999; 20: 27–30 2. McLennan W. 1997 Year Book Australia. Australian Bureau of Statistics. Canberra: Australian Government Publishing Service, p. 74
9
3. State of California, Department of Finance, City/County Population Estimates, with Annual Percent Change, January 1, 1997 and 1998. Sacramento, California, May 1998 4. State of California, Department of Finance, Population Estimates of California Cities and Counties January 1, 1981 to January 1, 1990. Sacramento, California 5. Baume P, McTaggart P. Suicides in Australia. In: Kosky RJ, Eshkevari HS, Goldney RD, Hassan R (eds) Suicide Prevention. The Global Context. New York: Plenum Press, 1998, 67–78 6. Causes of Death, Australia, 1995. Catalogue No. 3303.0. Australian Bureau of Statistics. Canberra: Australian Government Publishing Service, 1996 7. Goldney RD, Harrison J. Suicide in the elderly: some good news. Aust J Age 1998; 2: 54–55 8. Krupinski J, Tiller JWG, Burrows GD, Mackenzie A. Predicting suicide risk among young suicide attempters. In: Kosky RJ, Eshkevari HS, Goldney RD, Hassan R (eds) Hassan R Suicide Prevention. The Global Context. New York: Plenum Press, 1998, 93–97 9. Cantor CH, Leenaars AA, Lester D, Salter PJ, Wolanski AM, O’Toole B. Suicide trends in eight predominantly Englishspeaking countries 1960–1989. Soc Psychiatry Psychiatr Epidemiol 1996; 31: 364–373 10. Pritchard C. New patterns of suicide by age and gender in the United Kingdom and the Western World 1974–1992; an indicator of social change. Soc Psychiatry Psychiatr Epidemiol 1996; 31: 364–373 11. Harrison J, Moller J, Bordeaux S. Youth suicide and selfinjury Australia. Australian Injury Prevention Bulletin, Supplement to Issue 15, 1995 12. Beautrais AL. Risk factors for serious suicide attempts among young people. A case control study. In: Kosky RJ, Eshkevari HS, Goldney RD, Hassan R (eds) Suicide Prevention. The Global Context. New York: Plenum Press, 1998, 167–181 13. Goldney RD. Suicide in the young. J Paediatr Child Health 1993; 29 (Suppl 1): S50–52 14. Tiller JWG, Krupinski J, Burrows GD, Mackenzie A, Hallenstein H, Johnstone G. Youth suicide. The Victorian Coroner’s study. In: Kosky RJ, Eshkevari HS, Goldney RD, Hassan R (eds) Suicide Prevention. The Global Context. New York: Plenum Press, 1998, 87–91 15. Roesler J. The incidence of child suicide in Minnesota. Minn Med 1997; 80: 45–47 16. Males M. California’s suicide decline, 1970–1990. Suic Life Threat Behav 1994; 24: 24–37 17. Hassan R. Suicide Explained: The Australian Experience. Melbourne: Melbourne University Press, 1995, 50 18. O’Donnell I, Farmer R. The limitations of official suicide statistics. Brit J Psychiatr. 1995; 166: 458–461 19. Dudley M, Kelk N, Florio T, Waters B, Howard J, Taylor D. Coroner’s records of rural and non-rural cases of youth suicide in New South Wales. Aust NZ J Psychiatr 1998; 32: 242–251 20. Dudley M, Kelk N, Florio T, Howard J, Waters B, Haski C, Alcock M. Suicide among young rural Australians 1964–1993: a comparison with metropoliton trends. Soc Psychiatry Psychiatr Epidemiol 1997; 32: 251–260 21. Bell CC, Clark DC. Adolescent suicide. Pediatr Clin Nth Am 1998; 45: 365–380