Suicide in young people under 15 years: problems of classification

The aim of this paper is to examine the classification of suicide in children and young adolescents. Although under-classification of suicide in the very young is a well-known problem, our hypothesis was that accidents might wrongly be classified as suicides, leading to over-classification. This may more easily occur in the very young.

Information about all registered young suicides under 20 years of age in Norway in 1990-92 was gathered from professional informants. The suicides were reclassified as certain, uncertain or improbable suicide. People under 15 years of age (n=14) were compared with late adolescent suicides (15-19 years) (n=115).

Uncertain or improbable suicides were significantly more common in the very young (50% vs. 5%, P<0.001). In contrast to the very young who completed suicide, the very young with uncertain suicide had few risk factors (mental disorders, broken families, known stressors or precipitants, suicide intent and farewell notes). Clinical vignettes are given.

Some accidents in children may wrongly have been classified as suicide. Cases of death following experimenting or imitations of models from television or fiction should rather be classified as accidents or undetermined deaths. Misclassification of suicide may be an unnecessary burden to families and peers.