Mette Ystgaard Centre for Children and Adolescent Mental Health, Oslo, Norway

1. Risk factors associated with suicidal behaviour among young people Mette Ystgaard Centre for Children and Adolescent Mental Health, Oslo, Norway 1st European Conference on Injury Prevention and Safety Ptomotion, 25-27th June, Vienna

2. Objectives • To present an overview of risk factors associated with suicidal behaviour in young people • To examine differences between young people who do come to the attention of health care services following DSH and those who do not

3. Risk factors associated with suicidal behaviour in young peopleMethodology • Literature search, incl. Pubmed, Medline, PsychLit, EMBASE < 2005 (reviews and individual studies) • Inclusion criteria: Majority of participants were aged12-20 years Data collection through self-report / interview The prevalence of non-fatal suicidal behaviour (deliberate self harm / attempted suicide) was reported • Studies identified: 16 individual studies and 3 reviews

4. Results Risk factors associated with non-fatal suicidal behaviour Mental health problems: • Depressive disorders (except 1 study, all sign.) • Anxiety disorders and symptoms (except 1 study, all sign.) • Eating disorders and symptoms (sign. association for females aged 18 years and older) • Alcohol use (sign. association for high level of alcohol use and strong alcoholic drinks, both males and females) • Illicit drug use (sign. association for hard drugs, e.g. cocaine) • Hopelessness (sign. association for males and females aged 18 years and older) • Self esteem (sign. association between low self esteem in females)

5. Results Risk factors associated with non-fatal suicidal behaviour Other personal characteristics and experiences: • Sexual orientation (sign. association for homosexual orientation in both genders and bisexual orientation in females) • Physical and sexual abuse (majority of studies among women) • Suicide in family members (indirect association) • Suicidal behaviour by friends (indications for direct association) • Exposure to suicide in the media (only 3 studies)

6. Results Risk factors associated with non-fatal suicidal behaviour Educational and social factors: • School achievement and performance (sign. association for poor academic performance) • Peer relationships (sign. association for problems in relationships with peers) • Leisure activities (sign. association for increased participation in sports for females)

7. Differences between young people who do come to the attention of health care services following DSH and those who do notMethodology • International collaborative study: 6 research centres in Europe and 1 centre in Australia (CASE study) • Cross-sectional design, using an anonymous self-report questionnaire • Random selection of secondary schools • Mental health aspects included in the questionnaire: socio-demographic information, lifestyle, coping, alcohol and drug use, deliberate self-harm (DSH), depression, anxiety, impulsivity and self-esteem, and contact with health care services • yiont

8. Results • Total N students, aged 15-16 years participating in survey: 30,532 • N students reporting an act of DSH in the year prior to the survey: 1,660 (5.4%) (61% females) • Help received following the act of DSH: Health services: 18.8% Social network only: 32.8% No help: 48.4%

9. ResultsMethods of Deliberate Self Harm

10. Factors significantly associated with receiving helpfrom health services following DSH - Girls

11. Factors significantly associated with receiving helpfrom health services following DSH - Boys

12. Factors significantly associated with receiving helpfrom their social network following DSH - Girls

13. Factors significantly associated with receiving helpfrom their social network following DSH - Boys

14. Conclusions • Adolescents who engage in deliberate self harm and who have been in contact with health services report more problems than those who do not receive medical help • However, those who do not receive medical help, are also heavily burdened by mental health problems and negative life events • The findings underline the need to prioritise prevention and awareness programmes to improve early identification of young people who are at risk of suicidal behaviour, with specific emphasis on those who are “hidden” from the health services

15. Progress and challenges Progress so far... • International picture of the extent of non-fatal suicidal behaviour in young people • Insight into risk factors associated with non-fatal suicidal behaviour in young people • International collaborative research and prevention networks focusing on suicidal behaviour in young people (e.g. CASE, SAYLE) Challenges... • Explaining cross-cultural differences in suicidal behaviour among young people across different countries • Identifying “hidden” cases of deliberate self harm / mental health problems in young people • Prioritise evidence based mental health promotion programmes

16. How to identify “hidden” cases of deliberate self harm? Suicide Deliberate self harm medically treated “Hidden” cases of deliberate self harm and related mental health problems