Edinburgh Napier University

  Background
Suicide rates have been increasing in recent years after a period of decline since the 1990s, with notable increases in those aged 15-24. Childhood adversity is a known risk factor for later suicide.

Research objectives
We aimed to find out when young people who died by suicide had previously been admitted to hospital for adversity, mental health or self-harm, a time when earlier intervention with suicide prevention activities may help. The underlying causes of adversity were summarised to inform the types of contacts emergency services may encounter.

Methods
We analysed hospital records belonging to 2,477 people who were born from 1981 onwards. This was a retrospective longitudinal case control study and we compared these records with 24,777 randomly selected people from the general population.

Results
We found 8% of young people who died by suicide had a first hospital admission for childhood adversity aged 10-17, compared with 3% of the general population. Of the young men who died (average age 23), most (81%) first episodes were for assault serious enough for admission to general hospital. The odds of dying by suicide after first admission to hospital was 9.2 times higher for mental health problems followed by childhood adversity and 7.7 times higher for childhood adversity followed by mental health. This compared with almost 3.9 times the odds of dying for mental health first admissions only.

Conclusions
There was strong evidence of an association between first hospital admissions in adolescence for childhood adversity and/ or mental health (either order) and later young person suicide. These data support the need for early suicide prevention activity for those who support children pre-hospital emergency care as well as in-patient activity.