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. 2022 Aug;67(8):598-607.
doi: 10.1177/07067437211058602. Epub 2021 Nov 30.

Near-Fatal Self-Harm Among Canadian Adolescents

Rachel Hb Mitchell  1 , Cornelius Ani  2 , Claude Cyr  3 , James Irvine  4 , Ari R Joffe  5 , Robin Skinner  6 , Sam Wong  5   7 , Antonia S Stang  8 , Melanie Laffin  9 , Daphne J Korczak  10
Affiliations

Near-Fatal Self-Harm Among Canadian Adolescents

Rachel Hb Mitchell et al. Can J Psychiatry. 2022 Aug.

Abstract
in English, French

Objective: To evaluate the clinical features of Canadian adolescents admitted to the intensive care unit (ICU) for medically serious self-harm.

Methods: 2700 Canadian paediatricians were surveyed monthly over two years (January 2017 to December 2018) through the Canadian Paediatric Surveillance Program to ascertain data from eligible cases.

Results: Ninety-three cases (73 female; age 15.2 ± 1.5) met the case definition. Four provinces reported the majority of cases: Quebec (n = 27), Ontario (n = 26), Alberta (n = 21), and British Columbia (n = 8). There were 10 deaths, 9 by hanging. Overdose and hanging were the most frequently reported methods of self-harm (74.2% and 19.4%, respectively). Overdose was more common in females (80.8% females vs. 50% males; χ2 = 7.8 (1), p = .005), whereas hanging was more common in males (35% males vs. 15.1% females, χ2 = 3.9 (1), p = .04). More females than males had a past psychiatric diagnosis (79% vs. 58%; χ2 = 4.1 (1), p = .06), a previous suicide attempt (55.9% vs. 29.4%, χ2 = 3.8 (1), p = .05), and prior use of mental health service (69.7% vs. 27.8%, χ2 = 10.4 (1), p = .001). Family conflict was the most commonly identified precipitating factor (43%) of self-harm.

Conclusions: Among Canadian adolescents admitted to the ICU with medically serious self-harm, females demonstrate a higher rate of suicide attempts and prior mental health care engagement, whereas males are more likely to die by suicide. These findings are consistent with data from other adolescent samples, as well as data from working-age and older adults. Therefore, a sex-specific approach to suicide prevention is warranted as part of a national suicide prevention strategy; family conflict may be a specific target for suicide prevention interventions among adolescents.

Objectif: Évaluer les caractéristiques cliniques des adolescents hospitalisés dans une unité de soins intensifs pour une autodestruction médicalement sérieuse.

Méthodes: 2700 pédiatres canadiens ont répondu à un sondage mensuel pendant deux ans (janvier 2017 à décembre 2018) dans le cadre du Programme canadien de surveillance pédiatrique pour vérifier les données des cas admissibles.

Résultats: Quatre-vingt-treize cas (73 de sexe féminin; âge 15,2 ± 1,5) répondaient à la définition de cas. Quatre provinces déclaraient la majorité des cas : Québec (n = 27), Ontario (n = 26), Alberta (n = 21), et Colombie-Britannique (n = 8). Il y a eu 10 décès, 9 par pendaison. La surdose et la pendaison étaient les méthodes plus fréquemment rapportées d'autodestruction (74,2 % et 19,4 %, respectivement). La surdose était plus commune chez les femmes (80,8 % femmes c. 50 % hommes; X2 = 7,8 (1), p = ,005), alors que la pendaison était plus commune chez les hommes (35 % hommes c. 15,1 % femmes, X2 = 3,9(1), p = ,04). Plus de femmes que d'hommes avaient un diagnostic psychiatrique passé (79 % c. 58 %; X2 = 4,1(1), p = ,06), une tentative de suicide précédente (55,9 % c. 29,4 %, X2 = 3,8(1), p = ,05), et une utilisation antérieure des services de santé mentale (69,7 % c. 27,8 %, X2 = 10,4(1), p = ,001). Le conflit familial était le facteur de précipitation le plus communément identifié (43 %) de l'autodestruction.

Conclusions: Chez les adolescents hospitalisés dans une unité de soins intensifs avec une autodestruction médicalement sérieuse, les femmes démontrent un taux plus élevé de tentatives de suicide et d'utilisation antérieure des soins de santé mentale, alors que les hommes sont plus susceptibles de mourir par suicide. Ces résultats sont conformes aux données d'autres échantillons d'adolescents, ainsi qu'aux données d'adultes en âge de travailler et plus âgés. Par conséquent, une approche sexospécifique de la prévention du suicide est justifiée dans le cadre d'une stratégie nationale de prévention du suicide; le conflit familial peut être une cible spécifique des interventions de prévention du suicide chez les adolescents.

Keywords: adolescent; children; self-harm; suicide attempt; youth.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Daphne Korczak receives salary support from the Department of Psychiatry, University of Toronto Academic Scholar Award. Dr. Rachel Mitchell receives salary support from the Department of Psychiatry, University of Toronto Academic Scholar Award and Sunnybrook Health Sciences Centre Academic Scholar Award. She has received an honourarium from Medscape for appearing in a documentary.

Figures

Figure 1.
Figure 1.
Outcome of intensive care unit admission.
Figure 2.
Figure 2.
Tenets to support a national suicide prevention strategy for youth in Canada. *Adolescents with gender-identity concerns were too few to examine in the current study; however, research strongly supports a gender-informed approach to suicide prevention among adolescents.
See this image and copyright information in PMC

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